bluuebunny/crossref_metadata_2025 huggingface dataset:
(178) Climacturia: Emerging Type of Urinary Incontinence, Its Prevalence, Risk Factors, and Management: A Systematic Review and Prevalence Meta-analysis
Authors: De Guzman S , Wilson T
Published: March 2024

Introduction

Climacturia is an emerging type of urinary incontinence which occurs immediately following orgasm. Both men and women may suffer from climacturia in equivocal rates. This phenomenon is becoming more problematic as it impacts physiological and psychosexual aspect of well-being and quality of life. While awareness of climacturia becomes evident, studies are inadequate to support evidenced-based management in primary and urologic care settings.

Objective

This study aimed to conduct a systematic review and prevalence meta-analysis of climacturia and investigate its risk factors and evidenced-based management.

Methods

A systematic review of 24 articles were conducted following PRISMA 2020 guidelines. The PubMed, CINAHL, and Cochrane Library database were searched using the word “climacturia” and phrase “orgasm associated urinary incontinence” respectively. Search limiters applied included literature written in English from year of inception to 2022. Title and abstract reviews were conducted on 78 articles. Articles which did not discuss climacturia, duplicates, and previous systematic reviews were excluded after full article review.

Results

The review accounts a total of N = 7798 subjects which are composed of N = 7629 (97.83%) males and N = 169 (2.17%) females with age range of 18 to 80 years old. A total of N = 2, 039 (26%) participants are with climacturia, N = 87 or 4.26% are females and N = 1, 931 or 95.74% are males. The risk factors associated with climacturia include sexually active male, history of prostate cancer after prostatectomy within 12 months of surgery or radiation therapy, increased Body Mass Index (BMI), erectile dysfunction (ED), increased urethral width, presence of urinary incontinence, pain-associated orgasm and loss of penile length after pelvic surgery, use of aides to obtain an erection, and increased incontinence scores for men. For women, the risk factors are high scores of female sexual function index (FSFI) and detrusor overactivity. The management for females is limited to pharmacologic therapy with use of antimuscarinic agents. While, behavioral therapy, pharmacologic regimen, pelvic floor muscle training (PFMT), surgery (sling procedure) are the management options for affected men.

Conclusions

Climacturia affects males more than females, however, the evidence to support the efficacy of treatment options for both sexes are equally inadequate. Primary care and Advanced Practice Providers in primary and urologic care settings are at best position to query patients for the presence of and manage climacturia in timely manner. Further research is needed to increase evidence supporting effective management of climacturia for both men and women.

Disclosure

No.
(180) Female Sexuality of Tunisian Women with Treated Breast Cancer
Authors: Souayeh N , Bettaieb H , Rouis H , Mbarki C , Hsayaoui N
Published: March 2024

Introduction

Breast cancer is a major health problem. Several treatment strategies are used to treat it such as lumpectomy or mastectomy surgery, chemotherapy, radiotherapy, and hormone therapy, which leads us to ask the following question: what impact does breast cancer and its treatments have on female sexuality?

Objective

The aims of our study were to assess the sexuality of Tunisian women with breast cancer in remission, and to determine the prevalence and nature of sexual dysfunction in this population.

Methods

We carried out a descriptive cross-sectional study, involving women aged under 60, followed up for treated non-metastatic breast cancer currently in remission, and having a regular sexual partner during the last month. Outpatients in the surgery and radiotherapy department of the "Salah-Azaiez" Institute were interviewed using a questionnaire including a validated Arabic version of FSFI (Female sexual function desire). Our study was carried out throughout a period of 3 months, from January 1st, 2023 to March 31st, 2023, this period allowed us to collect our necessary data.

Results

We included 120 women in our study. The majority were between 40 and 49 years with an average of 46.53. One-third (33.3%) had a university degree and 16.7% were senior executives. More than half of our population (56.7%) were menopausal and 12% were smokers. 85% of the women had children, and only 36% had breastfed their children exclusively. Half of the women had discovered the disease at stage II, and 52% of them had discovered it during breast self-examination. Surgical treatment was radical in 61.7% of women and conservative in 38.3%. Thus, 75% of the population had undergone chemotherapy, 93.3% had undergone radiotherapy and 71.7% were receiving hormone therapy. Only 5% of our study population had a sexual dysfunction prior to the disease and 78% of women had reported a change in their sex life after breast cancer, with the frequency of intercourse as the main parameter affected. Among the most common sexual complaints were decreased or absent sexual desire in 68.1% of cases, lack of sexual initiative (74.4%), vaginal dryness (48.9%), and dyspareunia (42.6%). The majority of interviewed women (83.3%) had presented with global sexual dysfunction, i.e. a total FSFI score ≤26.55 and the areas most affected were pain, lubrication, and orgasm. Radical surgical treatment, chemotherapy, and hormone therapy were significantly associated with impaired female sexuality (respectively p=0.0036; p=0.047 and p=0.001).

Conclusions

Our study highlighted the impact of breast cancer treatment on women's sex lives. Healthcare providers should acquire the necessary skills in order to explore female sexual disorders and suggest suitable management.

Disclosure

No.
(199) The Impact of Body Weight on Sexual Function on Woman
Authors: Kong M
Published: March 2024

Introduction

Female sexual dysfunction (FSD) is a complex disorder which has an impact on women regardless of their age and race, and related to a variety of biological, psychological, and social determinants. Sexuality impact quality of life through effects on the emotional and psychological health of a woman.

Objective

The purpose of this study is to investigate the impact of body weight on sexual function in women. The associations of sexual function with demographic and clinical variables were evaluated.

Methods

We performed a cross-sectional study of comparing female sexual function index in normal weight and obese women. Patients with a diagnosis of benign gynecologic disease who admitted for gynecological surgery at our institution from January 2012 to December 2015 were evaluated. Total 349 women were enrolled in this study and complete the Female Sexual Function Index (FSFI) questionnaires. 264 women in normal weight group (body mass index, BMI <25 kg/m2) and 85 women in obese group (BMI ≥ 25 kg/m2) participated. Risk factors for female sexual function were examined using logistic regression models. We used a two-sample t-test and chi-square test for the categorical variables. Mann-Whitney U test for continuous variables and Fisher’s exact test for categorical variables

Results

The mean BMIs were 21.6±1.95 (mean±SD, kg/m2) in normal weight group and 27.6±2.56 in obese group (p < 0.001). There were also significant differences in age (mean±SD, 43.3±10.17 vs. 46.9±8.70 years, p = 0.002), parity (mean±SD, 1.5±0.99 vs. 1.9±1.19, p = 0.001), vaginal parity (mean±SD, 1.1±1.06 vs. 1.5±1.38, p = 0.043), marriage status (80.7% vs. 89.4%, p = 0.046) and hypertension (6.1% vs. 15.3%, p = 0.012). There were no differences in postmenopausal status, prior history of pelvic reconstructive surgery and urinary symptoms. In comparison of FSFI scores, there were significant differences in total score and all 6 domain scores (Desire, Arousal, Lubrication, Orgasm, Satisfaction and pain) between normal weight and obese group (p < 0.001). In the multiple logistic regression model for female sexual dysfunction, BMI, menopause and marriage were significantly different.

Conclusions

This study suggests that obesity has some impact on female sexual function. And menopause and marriage status are also associated with female sexual dysfunction. As obese woman population is increasing, the further study will be needed in a larger subgroup of women with long-term follow up period

Disclosure

No.
(211) Study of Postpartum Sexuality in Tunisian Women
Authors: Naouraz D , Rim B , Imen B
Published: March 2024

Introduction

Childbirth is a period of imbalance responsible for multidimensional changes that can influence sexual life. The aim of the study is to study the sexuality of women after childbirth, to specify the factors that influence it and to analyze the aspects of sexual dysfunction that accompany this period.

Objective

Evaluate women's postpartum experience and sexuality, while identifying difficulties that may arise during this high-risk period. Assess women's satisfaction with the information they receive on sexuality during perinatal and post-partum consultations.

Methods

This was a descriptive study that was spread over a period of 6 months from July 1, 2021 to December 31, 2021.200 women who gave birth in the six months preceding the study were included in the study. Two self-questionnaires were sent by internet through a social network.

Results

Our population of 200 women had a mean age of 34.3 years and the majority of women were urban, and university-educated. fourty-five per cent were second gestations and 58,5% of them had given birth by cesarean section. The average FSFI score in our sample was 21,99/36 postpartum, which implied sexual dysfunction in 72% of the women in our population. The delay in resumption of sexual activity was later in primiparous women, women with vaginal delivery and breastfeeding women. There was an association between instrumental delivery and the degree of dyspareunia. No difference was found in sexuality between vaginal delivery and caesarean section, nor for scheduled or emergency caesarean section. All areas of female sexual function were affected with mainly pain associated with sexuality. Some factors influencing the resumption of sexual activity could be identified such as breastfeeding, the presence of perineal tears, lack of lubrication and fear of becoming pregnant.

Conclusions

The majority of women in our population had sexual dysfunction in the postpartum period. The different areas of female sexual function were affected and correlated with the different parameters related to childbirth and the postpartum period.

Disclosure

No.
(215) Investigating if Hormonal Dysfunctions are Risk Factors in Men Complaining of Premature Ejaculation
Authors: Habous M , Nelson C , Mulhall J
Published: March 2024

Introduction

Most epidemiological studies suggest that premature ejaculation (PE), also referred to as early ejaculation and rapid ejaculation, may be the most common male sexual disorder. The exact etiology of PE is unknown. Psychological/behavioristic and biogenic etiologies have been proposed.

Objective

Initial reports indicate that there are hormone differences between men with primary (lifelong) and secondary (acquired) PE. This study was designed to investigate hormone profiles of these two subgroups.

Methods

Men who presented to our outpatient clinic with PE were enrolled in this study. The diagnosis and classification (primary or secondary) of PE was based on patient medical and sexual history according to guidelines of international society of sexual medicine (ISSM) and European association of urology (EAU). Complete physical examination was done and we measured thyroid stimulating hormone (TSH), testosterone (T), and prolactin (P) for all patients. Statistical analyses included descriptive statistics and independent-measures t-test for univariate analyses. Analysis of covariance was used for multivariable analyses.

Results

506 men were included in this analysis. The average age of these men was 44±12 years old and the mean body mass index (BMI) was 26.7±5.5. The mean levels of T, TSH, and P for the entire sample was 4.38±1.69, 2.31±3.56, and 10.56±11.04, respectively. There were 267 men in the primary PE group and 239 men in the secondary PE group. The men with primary PE were significantly younger than those with secondary PE (37±11 vs. 52±12, p=0.001). There were no significant differences in BMI between the groups. On univariate analyses, there was no differences between the primary PE and secondary PE groups in T (4.39±1.66 vs. 4.38±1.84, p=0.94), TSH (2.31±4.89 vs. 2.20±2.07, p=0.76), and P (10.65±8.13 vs. 10.46±13.46, p=0.86). When controlling for age in multivariable analyses, there continued to be no differences between the two groups (p values ranging from p=0.56 to 0.81).

Conclusions

hormonal profile including T, TSH and P seem to be in the normal range in men with PE and there is no statistical difference in these hormones between primary and secondary PE

Disclosure

No.
(262) Salvage Penile Prosthetic Surgery, Unique Surgical Technique. Institutional Experience
Authors: Kattan S , Almalki A , Alhumaid S
Published: March 2024

Introduction

`-Penile prosthesis surgery represents the end-stage treatment for erectile dysfunction. It is conventionally used only in cases of erectile dysfunction refractory to pharmacological treatments. -Penile prothesis surgery is associated with a high satisfaction rate and a low complication profile. However, it must be appreciated that the complications of surgery can have devastating consequences on a patient's quality of life and satisfaction and include infection, prosthesis malfunction, penile corporal perforation and penile length loss. -This study discusses the diagnosis and management of infected penile prosthesis with highlighting special intra-operative surgical technique that might be a valuable step in Salvage penile prosthetic surgery

Objective

Since its introduction in 1996 Mulcahy salvage has significantly improved outcomes for the removal and replacement of infected penile prostheses. Long-term follow up data of Mulcahy salvage show an infection-free rate of 82%. In our study we evaluated the Salvage Penile Prosthetic Surgery Cases done in our tertiary institution since (2000 up to date) and introduce the unique surgical technique that resulted in reduction the re-infetion rate.

Methods

This is a retrospective, institutional review

Results

total of 13 Salvage penile prosthetic surgeries done in our tertiary center since between 2000 and 2023 out of them only one case developed reinfection and ended with penile prosthesis removal. Therefor, the rate of re-infection is 8% comparing with latest successe rate of Mulcahy technique (18%) We applied surgical step intra- operative that might be the underling reason of decreasing the the reinfection rate that will be presented in details.

Conclusions

This retrospective analysis of salvage procedures and replacement of infected penile prosthesis with malleable prosthesis shows a high infection-free rate.

Disclosure

No.
Humoral immunogenicity of primary yellow fever vaccination in infants and children: a systematic review, meta-analysis and meta-regression
Authors: Ferrara Pietro , Losa Lorenzo , Mantovani Lorenzo G , Ambrosioni Juan , Agüero Fernando
Published: March 2024

Background

Vaccination plays a critical role in mitigating the burden associated with yellow fever (YF). However, there is a lack of comprehensive evidence on the humoral response to primary vaccination in the paediatric population, with several questions debated, including the response when the vaccine is administered at early ages, the effect of co-administration with other vaccines, the duration of immunity and the use of fractional doses, among others. This study summarizes the existing evidence regarding the humoral response to primary YF vaccination in infants and children.

Methods

Studies on the humoral response to primary YF vaccination in children aged 12 years or younger were reviewed. The humoral vaccine response rate (VRR), i.e. the proportion of children who tested positive for vaccine-induced YF-specific neutralizing antibodies, was pooled through random-effects meta-analysis and categorized based on the time elapsed since vaccination. Subgroup, meta-regression and sensitivity analyses were performed.

Results

A total of 33 articles met the inclusion criteria, with all but one conducted in countries where YF is endemic. A total of 14 028 infants and children entered this systematic review. Within three months following vaccination, the pooled VRR was 91.9% (95% CI 89.8–93.9). A lower VRR was observed with the 17DD vaccine at the meta-regression analysis. No significant differences in immunogenicity outcomes were observed based on age, administration route, co-administration with other vaccines, or fractional dosing. Results also indicate a decline in VRR over time.

Conclusions

Primary YF vaccination effectively provides humoral immunity in paediatric population. However, humoral response declines over time, and this decline is observable after the first 18 months following vaccination. A differential response according to the vaccine substrain was also observed. This research has valuable implications for stimulating further research on the primary YF vaccination in infants and children, as well as for informing future policies.
Elder abuse
Authors: Crome Peter , Arora Amit , Arora Anmol
Published: March 2024

Elder abuse is still under-reported and under-recognized in many cases. This chapter discusses definitions of elder abuse and key issues related to this serious problem including barriers that prevent vulnerable older people seeking help. This chapter also examines the role of health professionals in early identification and management of elder abuse. It explores some of the indicators of elder abuse that can help non-clinicians identify older people at risk of harm. This chapter also describes the current procedure for management of elder abuse in England and some other countries and covers some information about laws relevant to elder abuse. Support services and non-governmental organizations are an important resource for helping victims of elder abuse and their role is described briefly in this chapter.
Never Die Alone: Donald Goines, Black Iconicity, and Série Noire
Authors: Manditch-Prottas Zachary
Published: March 2024

Depending on who you ask, Donald Goines is a pioneer of Black popular fiction or a purveyor of shoddy pulp. This duality is illustrative of an impasse between American intelligentsia and Goines’s folk readership. Goines wrote sixteen novels between 1971-74 that have remained in print for sixty years with sales in the millions. Yet Goines remains an understudied American author and unacknowledged in the transnational reach of his writing. This essay offers the first scholarly consideration of Donald Goines’s status as a transnational author. Specifically, I analyze Goines’s promotion and reception in America and France. I will focus on Goines’s two prime distributors: Holloway House Publishing, which debuted Goines’s novels as the premier works of its Black Experience Books imprint in the early 1970s, and Gallimard Publishing, which translated Goines’s work into French as part of its famed crime fiction imprint, Série Noire, in the 1990s and early 2000s. This transnational comparative approach draws on three archives: Holloway House’s promotional materials that endorse Goines as the unprecedented authentic authorial voice of American Blackness, an unexamined element of the Holloway House archive that promotes Goines as an internationally revered author, and the nearly unacknowledged materials of Goines’s French publisher Gallimard that situate Goines as an author of American noir. Holloway House’s shift in promotional tactics and Série Noire’s prioritization of Goines as an author of American noir has two telling implications. First, it exposes how the racially essentialist logic of Holloway House linked authorial experience and literary fiction to promote the “authentic” Black experience as tethered to criminality. Second, it situates Goines in an internationally recognized US tradition of crime fiction in a way still largely unacknowledged in the United States.
Reconstructing the baryonic acoustic oscillations in the presence of photo-z uncertainties
Authors: Chan Kwan Chuen , Lu Guoyuan , Wang Xin
Published: March 2024

The reconstruction method has been widely employed to improve the baryon acoustic oscillations (BAO) measurement in spectroscopic survey data analysis. In this study, we explore the reconstruction of the BAO signals in the realm of photometric data. By adapting the Zel’dovich reconstruction technique, we develop a formalism to reconstruct the transverse BAO in the presence of photo-z uncertainties under the plane-parallel approximation. We access the performance of the BAO reconstruction through comoving N-body simulations. The transverse reconstruction potential can be derived by solving a 2D potential equation, with the surface density and the radial potential contribution acting as the source terms. The solution is predominantly determined by the surface density. As is evident in dense samples, such as the matter field, the transverse BAO reconstruction can enhance both the strength of the BAO signals and their cross correlation with the initial conditions. At z = 0, the cross-correlation is increased by a factor of 1.2 at $k_\perp = 0.2 \, \mathrm{Mpc}^{-1}h$ and 1.4 at $k_\perp = 0.3 \, \mathrm{Mpc}^{-1}h$, respectively. We contrast the 2D potential results with the 3D Poisson equation solution, wherein we directly solve the potential equation using the position in photo-z space, and find good agreement. Additionally, we examine the impact of various conditions, such as the smoothing scales and the level of photo-z uncertainties, on the reconstruction results. We envision the straightforward application of this method to survey data.
Distinct function of Chlamydomonas CTRA-CTR transporters in Cu assimilation and intracellular mobilization
Authors: Strenkert Daniela , Schmollinger Stefan , Paruthiyil Srinand , Brown Bonnie C , Green Sydnee , Shafer Catherine M , Salomé Patrice , Nelson Hosea , Blaby-Haas Crysten E , Moseley Jeffrey L , Merchant Sabeeha S
Published: March 2024

Successful acclimation to copper (Cu) deficiency involves a fine balance between Cu import and export. In the green alga Chlamydomonas reinhardtii, Cu import is dependent on a transcription factor, Copper Response Regulator 1 (CRR1), responsible for activating genes in Cu-deficient cells. Among CRR1 target genes are two Cu transporters belonging to the CTR/COPT gene family (CTR1 and CTR2) and a related soluble protein (CTR3). The ancestor of these green algal proteins was likely acquired from an ancient chytrid and contained conserved cysteine-rich domains (named the CTR-associated domains, CTRA) that are predicted to be involved in Cu acquisition. We show by reverse genetics that Chlamydomonas CTR1 and CTR2 are canonical Cu importers albeit with distinct affinities, while loss of CTR3 did not result in an observable phenotype under the conditions tested. Mutation of CTR1, but not CTR2, recapitulates the poor growth of crr1 in Cu-deficient medium, consistent with a dominant role for CTR1 in high-affinity Cu(I) uptake. On the other hand, the overaccumulation of Cu(I) (20 times the quota) in zinc (Zn) deficiency depends on CRR1 and both CTR1 and CTR2. CRR1-dependent activation of CTR gene expression needed for Cu over-accumulation can be bypassed by the provision of excess Cu in the growth medium. Over-accumulated Cu is sequestered into the acidocalcisome but can become remobilized by restoring Zn nutrition. This mobilization is also CRR1-dependent, and requires activation of CTR2 expression, again distinguishing CTR2 from CTR1 and consistent with the lower substrate affinity of CTR2.

One sentence summary

Regulation of Cu uptake and sequestration by members of the CTR family of proteins in Chlamydomonas.
Origin, evolution, and maintenance of gene-strand bias in bacteria
Authors: Atre Malhar , Joshi Bharat , Babu Jebin , Sawant Shabduli , Sharma Shreya , Sankar T Sabari
Published: March 2024

Gene-strand bias is a characteristic feature of bacterial genome organization wherein genes are preferentially encoded on the leading strand of replication, promoting co-orientation of replication and transcription. This co-orientation bias has evolved to protect gene essentiality, expression, and genomic stability from the harmful effects of head-on replication-transcription collisions. However, the origin, variation, and maintenance of gene-strand bias remain elusive. Here, we reveal that the frequency of inversions that alter gene orientation exhibits large variation across bacterial populations and negatively correlates with gene-strand bias. The density, distance, and distribution of inverted repeats show a similar negative relationship with gene-strand bias explaining the heterogeneity in inversions. Importantly, these observations are broadly evident across the entire bacterial kingdom uncovering inversions and inverted repeats as primary factors underlying the variation in gene-strand bias and its maintenance. The distinct catalytic subunits of replicative DNA polymerase have co-evolved with gene-strand bias, suggesting a close link between replication and the origin of gene-strand bias. Congruently, inversion frequencies and inverted repeats vary among bacteria with different DNA polymerases. In summary, we propose that the nature of replication determines the fitness cost of replication-transcription collisions, establishing a selection gradient on gene-strand bias by fine-tuning DNA sequence repeats and, thereby, gene inversions.
Nonspecific phospholipases C3 and C4 interact with PIN-FORMED2 to regulate growth and tropic responses in Arabidopsis
Authors: Li Teng , Zhang Shujuan , Yao Shuaibing , Li Xuebing , Jia Qianru , Yuan Jingya , Zhang Wenhua , Wang Xuemin , Zhang Qun
Published: March 2024

The dynamic changes in membrane phospholipids affect membrane biophysical properties and cell signaling, thereby influencing numerous biological processes. Nonspecific phospholipase C (NPC) enzymes hydrolyze common phospholipids to release diacylglycerol (DAG), which is converted to phosphatidic acid (PA) and other lipids. In this study, 2 Arabidopsis (Arabidopsis thaliana) tandemly arrayed genes, NPC3 and NPC4, were identified as critical factors modulating auxin-controlled plant growth and tropic responses. Moreover, NPC3 and NPC4 were shown to interact with the auxin efflux transporter PIN-FORMED2 (PIN2). The loss of NPC3 and NPC4 enhanced the endocytosis and vacuolar degradation of PIN2, which disrupted auxin gradients and slowed gravitropic and halotropic responses. Furthermore, auxin-triggered activation of NPC3 and NPC4 is required for the asymmetric PA distribution that controls PIN2 trafficking dynamics and auxin-dependent tropic responses. Collectively, our study reveals an NPC-derived PA signaling pathway in Arabidopsis auxin fluxes that is essential for fine-tuning the balance between root growth and environmental responses.
Macrophage activation syndrome in patients with systemic juvenile idiopathic arthritis on anti-interleukin-1 or -6 therapy
Authors: Ulu Kadir , Aliyev Emil , Kılıç Könte Elif , Tanatar Ayşe , Türkmen Şeyma , Doğantan Şeyda , Kızıldağ Zehra , Kasap Demir Belde , Gezgin Yıldırım Deniz , Otar Yener Gülçin , Öztürk Kübra , Baba Özge , Açarı Ceyhun , Kılbaş Gülşah , Taşkın Sema Nur , Haşlak Fatih , Çağlayan Şengül , Bağlan Esra , Dundar Hatice Adıgüzel , Başaran Özge , Barut Kenan , Karadağ Şerife Gül , Coşkuner Taner , Sönmez Hafize Emine , Yüksel Selçuk , Kalyoncu Mukaddes , Bakkaloğlu Sevcan A , Ünsal Erbil , Paç Kısaarslan Ayşenur , Bilginer Yelda , Aktay Ayaz Nuray , Kasapçopur Özgür , Özen Seza , Sözeri Betül
Published: March 2024

Objectives

The aim of this study is to investigate the effect of anti-interleukin (IL)-1/-6 biologics on systemic juvenile idiopathic arthritis (sJIA)-associated macrophage activation syndrome (MAS).

Methods

Demographic, clinical and laboratory data of patients followed up with a diagnosis of sJIA-associated MAS assessed from sixteen paediatric rheumatology centres across the country. The clinical and laboratory features of MAS developing while on biological drugs were compared with those without this treatment.

Results

One hundred and sixty-two patients were included in the study. Forty-five of the MAS events were detected under the effect of anti-IL-1/-6 biologics, while the patients experiencing the remaining 155 events have not received biological treatment in the last three months. Platelet count [128 (72–232) vs 199 (130–371) 109/l], ferritin level on admission [1107 (676–2050) vs 2863 (1193–9562) ng/ml], C-reactive protein level [15.4 (2.9–56) vs 90 (32–160) mg/l], erythrocyte sedimentation rate [13 (3–36) vs 43.5 (13–77) mm/h] and fever duration [5 (4–7.5) vs 10 (7–14.3) days] were found lower in the group under the impact of anti-IL-1/-6 biologics. Among patients treated with biologics, 26.6% did not meet the published 2016 MAS classification criteria at presentation. The rates of hepatomegaly and splenomegaly were relatively lower in the canakinumab-treated group when compared with those receiving other biologicals or to patients, not on biologicals.

Conclusion

Anti-IL-1/-6 therapies can mask the clinical and laboratory features of MAS, and proposed guidelines for MAS classification criteria may not be met.
The intersection of pediatric anesthesiology and social determinants of health
Authors: Martin Sarah R. , Kain Zeev N.
Published: March 2024

Purpose of review

There is increasing evidence of racial and ethnic disparities in pediatric perioperative care, which indicates a need to identify factors driving disparities. Social determinants of health (SDOH) play a fundamental role in pediatric health and are recognized as key underlying mechanisms of healthcare inequities. This article summarizes recent research exploring the influence of SDOH on pediatric perioperative outcomes.

Recent findings

Despite the scarcity of research exploring SDOH and pediatric perioperative outcomes, recent work demonstrates an association between SDOH and multiple outcomes across the perioperative care continuum. Measures of social disadvantage were associated with preoperative symptom severity, longer hospital stays, and higher rates of postoperative complications and mortality. In some studies, these adverse effects of social disadvantage persisted even when controlling for medical comorbidities and clinical severity.

The existing literature offers compelling evidence of the impact of SDOH on perioperative outcomes in children and reveals a critical area in pediatric anesthesia that necessitates further exploration and action. To improve outcomes and address care inequities, future efforts should prioritize the integration of SDOH assessment into pediatric perioperative research and practice.
Advances in pediatric perioperative care using artificial intelligence
Authors: Dundaru-Bandi Dominique , Antel Ryan , Ingelmo Pablo
Published: March 2024

Purpose of this review

This article explores how artificial intelligence (AI) can be used to evaluate risks in pediatric perioperative care. It will also describe potential future applications of AI, such as models for airway device selection, controlling anesthetic depth and nociception during surgery, and contributing to the training of pediatric anesthesia providers.

Recent findings

The use of AI in healthcare has increased in recent years, largely due to the accessibility of large datasets, such as those gathered from electronic health records. Although there has been less focus on pediatric anesthesia compared to adult anesthesia, research is on- going, especially for applications focused on risk factor identification for adverse perioperative events. Despite these advances, the lack of formal external validation or feasibility testing results in uncertainty surrounding the clinical applicability of these tools.

The goal of using AI in pediatric anesthesia is to assist clinicians in providing safe and efficient care. Given that children are a vulnerable population, it is crucial to ensure that both clinicians and families have confidence in the clinical tools used to inform medical decision- making. While not yet a reality, the eventual incorporation of AI-based tools holds great potential to contribute to the safe and efficient care of our patients.
Numerical Simulations of the Epley Maneuver With Clinical Implications
Authors: Arán-Tapia Ismael , Soto-Varela Andrés , Pérez-Muñuzuri Vicente , Santos-Pérez Sofía , Arán Ismael , Muñuzuri Alberto P.
Published: March 2024

Objectives:

Canalith repositioning procedures to treat benign paroxysmal positional vertigo are often applied following standardized criteria, without considering the possible anatomical singularities of the membranous labyrinth for each individual. As a result, certain patients may become refractory to the treatment due to significant deviations from the ideal membranous labyrinth, that was considered when the maneuvers were designed. This study aims to understand the dynamics of the endolymphatic fluid and otoconia, within the membranous labyrinth geometry, which may contribute to the ineffectiveness of the Epley maneuver. Simultaneously, the study seeks to explore methods to avoid or reduce treatment failure.

Design:

We conducted a study on the Epley maneuver using numerical simulations based on a three-dimensional medical image reconstruction of the human left membranous labyrinth. A high-quality micro-computed tomography of a human temporal bone specimen was utilized for the image reconstruction, and a mathematical model for the endolymphatic fluid was developed and coupled with a spherical particle model representing otoconia inside the fluid. This allowed us to measure the position and time of each particle throughout all the steps of the maneuver, using equations that describe the physics behind benign paroxysmal positional vertigo.

Results:

Numerical simulations of the standard Epley maneuver applied to this membranous labyrinth model yielded unsatisfactory results, as otoconia do not reach the frontside of the utricle, which in this study is used as the measure of success. The resting times between subsequent steps indicated that longer intervals are required for smaller otoconia. Using different angles of rotation can prevent otoconia from entering the superior semicircular canal or the posterior ampulla. Steps 3, 4, and 5 exhibited a heightened susceptibility to failure, as otoconia could be accidentally displaced into these regions.

Conclusions:

We demonstrate that modifying the Epley maneuver based on the numerical results obtained in the membranous labyrinth of the human specimen under study can have a significant effect on the success or failure of the treatment. The use of numerical simulations appears to be a useful tool for future canalith repositioning procedures that aim to personalize the treatment by modifying the rotation planes currently defined as the standard criteria.
A New Computed Tomography-based Measure that Provides Insight into Hip Stability in Patients with Posterior Wall Acetabular Fractures
Authors: Jaeblon Todd , Demyanovich Haley , Bauer Brent , Beer Robert , Kufera Joseph
Published: March 2024

Objective:

Describe the technique and results of a new sagittal plane computed tomography (CT) based angular measure for predicting stability following posterior wall acetabular fractures (PWF).

Design:

Retrospective review

Setting:

Academic Level II Trauma center

Patients:

Fifty-eight consecutive patients with PWF (AO/OTA class 62A.1), 98% were high energy injuries.

Intervention:

A new sagittal CT (sCT) measure of PWF based upon the angle subtending the joint center, cranial and caudal fracture exits.

Outcome measures and Comparisons:

Hip incongruity or dislocation demonstrated using gold standard test, exam under anesthesia (EUA), or instability on static images. Prediction of hip instability utilizing a sCT angular measure based upon cranial and caudal fracture exits was compared to previous axial CT (aCT) measures suggestive of increased risk for instability including PW size >50%, and those with cranial exit within 5.0 mm of the acetabular dome.

Results:

There were 32 operative and 26 nonoperatively treated fractures. Thirty were determined to be unstable, and 28 stable following EUA. Measurements of >70° using the sCT angular measure predicted instability in 28/28 patients, and ≤70° predicted stability in 30/30 patients (sensitivity 100% specificity 100%). Prevalence of EUA confirmed instability for subgroups with PWF based on prior aCT measures were as follows: ≥50% wall involvement 11/16 (sensitivity 67% specificity 60%; 95%CI 45-89%/45-75%), fracture within 5.0 mm of dome 5/18 (sensitivity 86%, specificity 73%; 95%CI 71-100%/59-87%), fracture within 5.0 mm of dome and ≥50% involvement 1/9 (sensitivity 89%, specificity 56%, 95%CI 69-100%/24-88%).

Conclusion:

In a sample of 58 mostly high energy posterior wall fractures all having had an EUA, a new sagittal angular CT measurement of ≤70° predicted hip stability and >70° predicted instability with 100% sensitivity and specificity.

Level of evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Epigenetic dynamics of aging and cancer development: current concepts from studies mapping aging and cancer epigenomes
Authors: Bisht Shilpa , Mao Yiqing , Easwaran Hariharan
Published: March 2024

Purpose of review

This review emphasizes the role of epigenetic processes as incidental changes occurring during aging, which, in turn, promote the development of cancer.

Recent findings

Aging is a complex biological process associated with the progressive deterioration of normal physiological functions, making age a significant risk factor for various disorders, including cancer. The increasing longevity of the population has made cancer a global burden, as the risk of developing most cancers increases with age due to the cumulative effect of exposure to environmental carcinogens and DNA replication errors. The classical ‘somatic mutation theory’ of cancer cause is being challenged by the observation that multiple normal cells harbor cancer driver mutations without resulting in cancer. In this review, we discuss the role of age-associated epigenetic alterations, including DNA methylation, which occur across all cell types and tissues with advancing age. There is an increasing body of evidence linking these changes with cancer risk and prognosis.

A better understanding about the epigenetic changes acquired during aging is critical for comprehending the mechanisms leading to the age-associated increase in cancer and for developing novel therapeutic strategies for cancer treatment and prevention.
Special populations in metastatic renal cell carcinoma
Authors: Goodstein Taylor , Goldberg Ilana , Acikgoz Yusuf , Hasanov Elshad , Srinivasan Ramaprasad , Singer Eric A.
Published: March 2024

Purpose of review

This review focuses on special populations poorly represented in current evidence-based practice for metastatic renal cell carcinoma (mRCC). This includes the elderly and frail, patients on immunosuppression or with autoimmune diseases, patients with brain, liver, and/or bone metastases, and RCC with sarcomatoid features.

Recent findings

Certain populations are poorly represented in current trials for mRCC. Patients with central nervous system (CNS) metastases are often excluded from first-line therapy trials. Modern doublet systemic therapy appears to benefit patients with bone or liver metastases, but data supporting this conclusion is not robust. Post-hoc analyses on patients with sarcomatoid differentiation have shown improved response to modern doublet therapy over historical treatments. The elderly are underrepresented in current clinical trials, and most trials exclude all but high-performing (nonfrail) patients, though true frailty is likely poorly captured using the current widely adopted indices. It is difficult to make conclusions about the efficacy of modern therapy in these populations from subgroup analyses. Data from trials on other malignancies in patients with autoimmune diseases or solid organ transplant recipients on immunosuppression suggest that immune checkpoint inhibitors (ICIs) may still have benefit, though at the risk of disease flare or organ rejection. The efficacy of ICIs has not been demonstrated specifically for RCC in this group of patients.

The elderly, frail, and immunosuppressed, those with tumors having aggressive histologic features, and patients with brain, bone, and/or liver metastases represent the populations least understood in the modern era of RCC treatment.
Targeting androgen biosynthesis in prostate cancer: implications on endocrine physiology
Authors: Kango Ghazal , Malek Rana , Mannuel Heather , Hussain Arif
Published: March 2024

Purpose of review

Targeting specific steroidogenic enzymes is effective in decreasing testosterone synthesis, resulting in significant antitumor effects in prostate cancer. Such treatments result in disruptions of complicated and intertwining pathways with systemic physiologic consequences via effects on the adrenal gland and renin–angiotensin–aldosterone axis. This review highlights some of these aspects that need to be taken into consideration when treating patients with androgen biosynthesis inhibitors.

Recent findings

Targeting CYP17A1, a key enzyme involved in androgen biosynthesis, is a well established treatment in prostate cancer. More recently, efforts are underway to target a gatekeeper enzyme of steroidogenesis, CYP11A1. This enzyme mediates conversion of cholesterol to pregnenolone, the first step in steroid hormone biogenesis. Studies are beginning to demonstrate antitumor effects of ODM-208, a CYP11A1 inhibitor in prostate cancer. Although anticipated to have a therapeutic role in prostate cancer, there are potential downstream effects of CYP11A1 targeting arising from suppression of the entire adrenal cortex, including long-term adrenal insufficiency and possibly cardiovascular dysregulation.

Agents targeting androgen biosynthesis can have systemic implications. Balancing management of prostate cancer with better understanding of the mechanisms associated with potential side effects will allow for patients to obtain improved antitumor benefit while mitigating against treatment-associated adverse effects.
Current evidence of integrative oncology modalities for managing adverse effects and survivorship issues among adolescents and young adult (AYA) cancer patients and survivors
Authors: Yusuf Rukh , Ng Ding Quan , Torno Lilibeth , Chan Alexandre
Published: March 2024

Purpose of review

Symptom burden of cancer diagnosis and treatment has led adolescents and young adult cancer patients (AYAC) and survivors to seek different self-management strategies including integrative oncology (IO) modalities. IO holds great promise to improve survivorship issues in adolescents and young adult (AYA) cancer survivors. This review aims to encompass the current evidence of IO modalities and to analyze the efficacy of IO for managing survivorship issues among AYA cancer patients and survivors.

Recent findings

Nineteen randomized controlled trials included in this review evaluated mind and body modalities including both physical and psychological (74%) and psychological only (26%) modalities. Most assessed IO modalities were physical activity (PA) (37%) and structured exercise (10%). Most effective IO modalities found were PA, massage, mindfulness-based stress reduction (MBSR) and light therapy for treating AYA symptom burden. The Cochrane risk of bias (RoB-2) concluded 21% studies had high risk, 58% possessed some concerns and 21% had low risk.

Although evidence has shown that a number of IO modalities may improve survivorship among AYA cancer survivors, more rigorous study designs are needed in order for these modalities to be routinely recommended for use in clinical practice.
Molecular and nutritional markers in head and neck cancer
Authors: Milano Gerard , Gal Jocelyn , Bensadoun René-Jean
Published: March 2024

Purpose of review

There is still a need of biomarkers in the induction and neoadjuvant settings for squamous cell carcinoma of the head and neck (SCCHN). The objective of this concise review article is to give an overview on both predictive and prognostic biomarkers potentially useful for the management of SCCHN.

Recent findings

Human papilloma virus (HPV) positivity translated by the presence of the protein indicator p16 is synonymous of favorable prognosis SCCHN. However, there is some disparity for disease evolution among p16 positive SCCHN. A lack of correlation between immunohistochemistry (IHC) and precise quantification of active epidermal growth factor receptors (EGFRs) may explain the absence of link between EGFR expression performed by IHC and response to EGFR targeting therapies reported in SCCHN. Circulating tumor cells (CTCs) have the property to share the main somatic mutations and genetic rearrangements with the primary tumors. A particular potential interest lies on the possibility to predict patient outcome based on a single-CTC analysis.

This short review indicates that key biological marker reflecting disease outcome is not yet emerging for a clinical use in SCCHN. Hopes can be put into the so-called liquid biopsies incorporating circulating tumor cells and circulating tumor DNA.
“De Novo” Hypercapnic Respiratory Failure Unmasking Neuromuscular Disorders: Experiences From a Tertiary Care Center and Review of Literature
Authors: Nair Aditya Vijayakrishnan , Kandagaddala Madhavi , Sivadasan Ajith , Prabhakar A.T. , Nair Shalini , Mathew Vivek , Aaron Sanjith , Alexander Mathew
Published: March 2024

Objectives:

Neuromuscular disorders could have respiratory involvement early or late into illness. Rarely, patients may present with a hypercapnic respiratory failure (with minimal motor signs) unmasking an underlying disease. There are hardly any studies which have addressed the spectrum and challenges involved in management of this subset, especially in the real-world scenario.

Methods:

A retrospective study comprising consecutive patients hospitalized with hypercapnic respiratory failure as the sole/dominant manifestation. The clinical–electrophysiological spectrum, phrenic conductions, diaphragm thickness, and outcomes were analyzed.

Results:

Twenty-seven patients were included, the mean age was 47.29 (SD 15.22) years, and the median duration of respiratory symptoms was 2 months (interquartile range [IQR] 1–4). Orthopnea was present in 23 patients (85.2%) and encephalopathy in 8 patients (29.6%). Phrenic nerve latencies and amplitudes were abnormal in 83.3% and 95.6%, respectively. Abnormal diaphragm thickness was noted in 78.5%. Based on a comprehensive electrophysiological strategy and paraclinical tests, an etiology was established in all. Reversible etiologies were identified in 17 patients (62.9%). These included myasthenia gravis (anti-AChR and MuSK), inflammatory myopathy, riboflavin transporter deficiency neuronopathy, Pompe disease, bilateral phrenic neuritis, and thyrotoxicosis. Respiratory onset motor neuron disease was diagnosed in 8 patients (29.6%). Despite diaphragmatic involvement, a functional respiratory recovery was noted at discharge (45%) and last follow-up (60%). Predictors for good outcomes included female sex, normal nerve conductions, and recent-onset respiratory symptoms.

Discussion:

A good functional recovery was noted in most of the patients including respiratory onset motor neuron disease. A systematic algorithmic approach helps in proper triaging, early diagnosis, and treatment. Clinical and electrodiagnostic challenges and observations from a tertiary care referral center are discussed.