bluuebunny/crossref_metadata_2025 huggingface dataset:
Age, Period, and Cohort Analysis of Smoking Intensity Among Current Smokers in Malaysia, 1996–2015
Authors: Teh Chien Huey , Rampal Sanjay , Lim Kuang Hock , Azahadi Omar , Tahir Aris
Published: March 2023

Introduction

Tobacco use is one of the major preventable risk factors for premature death and disability worldwide. Understanding the trend of tobacco use over time is important for informed policy making.

Aims and Methods

The present study aimed to examine the changes in mean daily cigarette consumption among random samples of the Malaysian current smoker population over 20 years using an age-period-cohort (APC) approach. We conducted APC analysis using a multilevel hierarchical age-period-cohort model and data from four nationally representative, repeated cross-sectional surveys (National Health and Morbidity Survey) conducted in 1996, 2006, 2011, and 2015 among individuals aged 18 to 80 years. Analyses were also stratified by gender and ethnicity.

Results

Overall, mean daily cigarette consumption (smoking intensity) among current smokers increased with age until 60, after which a drop was observed. There were increases in daily cigarette consumption across birth cohorts. Age and cohort trends did not vary by gender but by ethnicity. The decreasing cigarette consumption after age 60 among the current smoker population was consistent with those observed among the Chinese and Indians, a trend that was not observed in Malays and other aborigines. In contrast, the increasing cohort trend was consistent with those observed among the Malays and other bumiputras.

Conclusions

The present study highlighted important ethnic-specific trends for mean daily cigarette consumption among the current smoker population in Malaysia. These findings are essential in guiding the formulation of interventional strategies or implementation of national tobacco control policies and help achieve the Ministry of Health Malaysia’s 2025 and 2045 targets for smoking prevalence.

Implications

This is the first APC study on smoking intensity among current smokers in a multiracial, middle-income nation. Very few studies had performed gender- and ethnic-stratified APC analyses. The ethnic-stratified APC analyses provide useful insights into the overall age and cohort trends observed among the current smoker population in Malaysia. Therefore, the present study could add evidence to the existing literature on the APC trends of smoking intensity. The APC trends are also important in guiding the government to develop, implement, and evaluate antismoking strategies.
Community-Onset Bacterial Coinfection in Children Critically Ill With Severe Acute Respiratory Syndrome Coronavirus 2 Infection
Authors: Moffitt Kristin L , Nakamura Mari M , Young Cameron C , Newhams Margaret M , Halasa Natasha B , Reed J Nelson , Fitzgerald Julie C , Spinella Philip C , Soma Vijaya L , Walker Tracie C , Loftis Laura L , Maddux Aline B , Kong Michele , Rowan Courtney M , Hobbs Charlotte V , Schuster Jennifer E , Riggs Becky J , McLaughlin Gwenn E , Michelson Kelly N , Hall Mark W , Babbitt Christopher J , Cvijanovich Natalie Z , Zinter Matt S , Maamari Mia , Schwarz Adam J , Singh Aalok R , Flori Heidi R , Gertz Shira J , Staat Mary A , Giuliano John S , Hymes Saul R , Clouser Katharine N , McGuire John , Carroll Christopher L , Thomas Neal J , Levy Emily R , Randolph Adrienne G
Published: March 2023

Background

Community-onset bacterial coinfection in adults hospitalized with coronavirus disease 2019 (COVID-19) is reportedly uncommon, though empiric antibiotic use has been high. However, data regarding empiric antibiotic use and bacterial coinfection in children with critical illness from COVID-19 are scarce.

Methods

We evaluated children and adolescents aged <19 years admitted to a pediatric intensive care or high-acuity unit for COVID-19 between March and December 2020. Based on qualifying microbiology results from the first 3 days of admission, we adjudicated whether patients had community-onset bacterial coinfection. We compared demographic and clinical characteristics of those who did and did not (1) receive antibiotics and (2) have bacterial coinfection early in admission. Using Poisson regression models, we assessed factors associated with these outcomes.

Results

Of the 532 patients, 63.3% received empiric antibiotics, but only 7.1% had bacterial coinfection, and only 3.0% had respiratory bacterial coinfection. In multivariable analyses, empiric antibiotics were more likely to be prescribed for immunocompromised patients (adjusted relative risk [aRR], 1.34 [95% confidence interval {CI}, 1.01–1.79]), those requiring any respiratory support except mechanical ventilation (aRR, 1.41 [95% CI, 1.05–1.90]), or those requiring invasive mechanical ventilation (aRR, 1.83 [95% CI, 1.36–2.47]) (compared with no respiratory support). The presence of a pulmonary comorbidity other than asthma (aRR, 2.31 [95% CI, 1.15–4.62]) was associated with bacterial coinfection.

Conclusions

Community-onset bacterial coinfection in children with critical COVID-19 is infrequent, but empiric antibiotics are commonly prescribed. These findings inform antimicrobial use and support rapid de-escalation when evaluation shows coinfection is unlikely.
PECTIN METHYLESTERASE INHIBITOR18 functions in stomatal dynamics and stomatal dimension
Authors: Zhang Xianwen , Guo Huimin , Xiao Chuanlei , Yan Zhiqiang , Ning Nina , Chen Gang , Zhang Jumei , Hu Honghong
Published: March 2023

Pectin methylesterification in guard cell (GC) walls plays an important role in stomatal development and stomatal response to external stimuli, and pectin methylesterase inhibitors (PMEIs) modulate pectin methylesterification by inhibition of pectin methylesterase (PME). However, the function of PMEIs has not been reported in stomata. Here, we report the role of Arabidopsis (Arabidopsis thaliana) PECTIN METHYLESTERASE INHIBITOR18 in stomatal dynamic responses to environmental changes. PMEI18 mutation increased pectin demethylesterification and reduced pectin degradation, resulting in increased stomatal pore size, impaired stomatal dynamics, and hypersensitivity to drought stresses. In contrast, overexpression of PMEI18 reduced pectin demethylesterification and increased pectin degradation, causing more rapid stomatal dynamics. PMEI18 interacted with PME31 in plants, and in vitro enzymatic assays demonstrated that PMEI18 directly inhibits the PME activity of PME31 on pectins. Genetic interaction analyses suggested that PMEI18 modulates stomatal dynamics mainly through inhibition of PME31 on pectin methylesterification in cell walls. Our results provide insight into the molecular mechanism of the PMEI18–PME31 module in stomatal dynamics and highlight the role of PMEI18 and PME31 in stomatal dynamics through modulation of pectin methylesterification and distribution in GC walls.
Store-operated Ca2+ entry regulatory factor alters murine metabolic state in an age-dependent manner via hypothalamic pathways
Authors: Gataulin Diana , Kuperman Yael , Tsoory Michael , Biton Inbal E , Nataniel Tomer , Palty Raz , Karbat Izhar , Meshcheriakova Anna , Reuveny Eitan
Published: March 2023

Store-operated calcium entry (SOCE) is a vital process aimed at refilling cellular internal Ca2+ stores and a primary cellular signaling driver for transcription factors’ entry to the nucleus. SOCE-associated regulatory factor (SARAF)/TMEM66 is an endoplasmic reticulum (ER)-resident transmembrane protein that promotes SOCE inactivation and prevents Ca2+ overfilling of the cell. Here, we demonstrate that mice deficient in SARAF develop age-dependent sarcopenic obesity with decreased energy expenditure, lean mass, and locomotion without affecting food consumption. Moreover, SARAF ablation reduces hippocampal proliferation, modulates the activity of the hypothalamus–pituitary–adrenal (HPA) axis, and mediates changes in anxiety-related behaviors. Interestingly, selective SARAF ablation in the hypothalamus's paraventricular nucleus (PVN) neurons reduces old age-induced obesity and preserves locomotor activity, lean mass, and energy expenditure, suggesting a possible central control with a site-specific role for SARAF. At the cellular level, SARAF ablation in hepatocytes leads to elevated SOCE, elevated vasopressin-induced Ca2+ oscillations, and an increased mitochondrial spare respiratory capacity (SPC), thus providing insights into the cellular mechanisms that may affect the global phenotypes. These effects may be mediated via the liver X receptor (LXR) and IL-1 signaling metabolic regulators explicitly altered in SARAF ablated cells. In short, our work supports both central and peripheral roles of SARAF in regulating metabolic, behavioral, and cellular responses.
Combinatorial classification of (±1)-skew projective spaces
Authors: Higashitani Akihiro , Ueyama  Kenta
Published: March 2023

The non-commutative projective scheme $\operatorname{\mathsf{Proj_{nc}}} S$ of a $(\pm 1)$-skew polynomial algebra S in n variables is considered to be a $(\pm 1)$-skew projective space of dimension n − 1. In this paper, using combinatorial methods, we give a classification theorem for $(\pm 1)$-skew projective spaces. Specifically, among other equivalences, we prove that $(\pm 1)$-skew projective spaces $\operatorname{\mathsf{Proj_{nc}}} S$ and $\operatorname{\mathsf{Proj_{nc}}} S^{\prime}$ are isomorphic if and only if certain graphs associated with S and Sʹ are switching (or mutation) equivalent. We also discuss invariants of $(\pm 1)$-skew projective spaces from a combinatorial point of view.
Assessing the radiation contamination of large areas using advanced technologies
Authors: Petrányi János , Zsitnyányi Attila , Jónás Jácint , Garai Zoltán , Kátai-Urbán Lajos , Vass Gyula
Published: March 2023

Military, disaster management and in many cases civilian tasks include surveying of a given section of terrain that is likely to be contaminated with radioactive materials. Such a measurement series can form the basis for the complete recultivation and decontamination of large areas. This survey can take place after an emergency situation. This paper will use concrete surveys to illustrate the efficiency of new measurement technologies and developments. All these technologies aim to carry out radiation reconnaissance tasks as quickly and accurately as possible. Different hot spots were found during on-foot radiation reconnaissance. During in-situ measurements, a Bayesian-based isotope identifying algorithm was used and the measured data were validated with results from gamma spectroscopy in the laboratory. A rapid on-site quantitative analysis was also performed by evaluating the samples taken next to the hot spots. In addition to the measurement, the data were generated and stored in a standard N42 format ideal for data exchange. Many issues were solved like how the measurement data are associated with relevant additional information (e.g. time and coordinate), and how the measurement results can be shared with other partner organisations. Another important consideration was the preparation of the team conducting the measurement. The total cost of the survey was significantly reduced by the fact that the measurement was manageable by one technician and one expert. A quality assurance system had to be established to meet all relevant standards and strict documentation requirements. In addition to operating at high background radiation, these measurements presented additional challenges due to the low activity of hidden and mixed radioactive sources.
Night-to-night reliability and agreement of obstructive sleep apnea pathophysiologic mechanisms estimated with phenotyping using polysomnography in cognitively normal elderly participants
Authors: Tolbert Thomas M , Schoenholz Reagan L , Parekh Ankit , Berkalieva Asem , Osorio Ricardo S , Ayappa Indu , Rapoport David M
Published: March 2023

Study Objectives

Phenotyping using polysomnography (PUP) is an algorithmic method to quantify physiologic mechanisms underlying obstructive sleep apnea (OSA): loop gain (LG1), arousal threshold (ArTH), and upper airway collapsibility (Vpassive) and muscular compensation (Vcomp). The consecutive-night test–retest reliability and agreement of PUP-derived estimates are unknown. From a cohort of elderly (age ≥55 years), largely non-sleepy, community-dwelling volunteers who underwent in-lab polysomnography (PSG) on 2 consecutive nights, we determined the test–retest reliability and agreement of PUP-estimated physiologic factors.

Methods

Participants who had an apnea–hypopnea index (AHI3A) of at least 15 events per hour on the first night were included. PUP analyses were performed on each of the two PSGs from each participant. Physiologic factor estimates were derived from NREM sleep and compared across nights using intraclass correlation coefficients for reliability and smallest real differences (SRD) for agreement.

Results

Two PSGs from each of 43 participants (86 total) were analyzed. A first-night effect was evident with increased sleep time and stability and decreased OSA severity on the second night. LG1, ArTH, and Vpassive demonstrated good reliability (ICC > 0.80). Vcomp had modest reliability (ICC = 0.67). For all physiologic factors, SRD values were approximately 20% or more of the observed ranges, suggesting limited agreement of longitudinal measurements for a given individual.

Conclusions

For NREM sleep in cognitively normal elderly individuals with OSA, PUP-estimated LG1, ArTH, and Vpassive demonstrated consistent relative ranking of individuals (good reliability) on short-term repeat measurement. For all physiologic factors, longitudinal measurements demonstrated substantial intraindividual variability across nights (limited agreement).
Pediatric sleep: current knowledge, gaps, and opportunities for the future
Authors: Reynolds Alexandria M , Spaeth Andrea M , Hale Lauren , Williamson Ariel A , LeBourgeois Monique K , Wong Sachi D , Hartstein Lauren E , Levenson Jessica C , Kwon Misol , Hart Chantelle N , Greer Ashley , Richardson Cele E , Gradisar Michael , Clementi Michelle A , Simon Stacey L , Reuter-Yuill Lilith M , Picchietti Daniel L , Wild Salome , Tarokh Leila , Sexton-Radek Kathy , Malow Beth A , Lenker Kristina P , Calhoun Susan L , Johnson Dayna A , Lewin Daniel , Carskadon Mary A
Published: March 2023

This White Paper addresses the current gaps in knowledge, as well as opportunities for future studies in pediatric sleep. The Sleep Research Society’s Pipeline Development Committee assembled a panel of experts tasked to provide information to those interested in learning more about the field of pediatric sleep, including trainees. We cover the scope of pediatric sleep, including epidemiological studies and the development of sleep and circadian rhythms in early childhood and adolescence. Additionally, we discuss current knowledge of insufficient sleep and circadian disruption, addressing the neuropsychological impact (affective functioning) and cardiometabolic consequences. A significant portion of this White Paper explores pediatric sleep disorders (including circadian rhythm disorders, insomnia, restless leg and periodic limb movement disorder, narcolepsy, and sleep apnea), as well as sleep and neurodevelopment disorders (e.g. autism and attention deficit hyperactivity disorder). Finally, we end with a discussion on sleep and public health policy. Although we have made strides in our knowledge of pediatric sleep, it is imperative that we address the gaps to the best of our knowledge and the pitfalls of our methodologies. For example, more work needs to be done to assess pediatric sleep using objective methodologies (i.e. actigraphy and polysomnography), to explore sleep disparities, to improve accessibility to evidence-based treatments, and to identify potential risks and protective markers of disorders in children. Expanding trainee exposure to pediatric sleep and elucidating future directions for study will significantly improve the future of the field.
Alterations of pain pathways by experimental sleep disturbances in humans: central pain-inhibitory, cyclooxygenase, and endocannabinoid pathways
Authors: Haack Monika , Engert Larissa C , Besedovsky Luciana , Goldstein Michael R , Devine Jaime K , Dang Rammy , Olia Keeyon , Molina Victoria , Bertisch Suzanne M , Sethna Navil , Simpson Norah
Published: March 2023

Study Objectives

There is strong evidence that sleep disturbances are an independent risk factor for the development of chronic pain conditions. The mechanisms underlying this association, however, are still not well understood. We examined the effect of experimental sleep disturbances (ESDs) on three pathways involved in pain initiation/resolution: (1) the central pain-inhibitory pathway, (2) the cyclooxygenase (COX) pathway, and (3) the endocannabinoid (eCB) pathway.

Methods

Twenty-four healthy participants (50% females) underwent two 19-day long in-laboratory protocols in randomized order: (1) an ESD protocol consisting of repeated nights of short and disrupted sleep with intermittent recovery sleep; and (2) a sleep control protocol consisting of nights with an 8-hour sleep opportunity. Pain inhibition (conditioned pain modulation, habituation to repeated pain), COX-2 expression at monocyte level (lipopolysaccharide [LPS]-stimulated and spontaneous), and eCBs (arachidonoylethanolamine, 2-arachidonoylglycerol, docosahexaenoylethanolamide [DHEA], eicosapentaenoylethanolamide, docosatetraenoylethanolamide) were measured every other day throughout the protocol.

Results

The central pain-inhibitory pathway was compromised by sleep disturbances in females, but not in males (p < 0.05 condition × sex effect). The COX-2 pathway (LPS-stimulated) was activated by sleep disturbances (p < 0.05 condition effect), and this effect was exclusively driven by males (p < 0.05 condition × sex effect). With respect to the eCB pathway, DHEA was higher (p < 0.05 condition effect) in the sleep disturbance compared to the control condition, without sex-differential effects on any eCBs.

Conclusions

These findings suggest that central pain-inhibitory and COX mechanisms through which sleep disturbances may contribute to chronic pain risk are sex specific, implicating the need for sex-differential therapeutic targets to effectively reduce chronic pain associated with sleep disturbances in both sexes.

Clinical Trials Registration

NCT02484742: Pain Sensitization and Habituation in a Model of Experimentally-induced Insomnia Symptoms. https://clinicaltrials.gov/ct2/show/NCT02484742.
L’appréciation du risque de confusion à l’épreuve du principe de la territorialité des droits de propriété industrielle dans l’espace OAPI
Authors: Bello Ibrahim
Published: March 2023

La délimitation du cadre géographique dans lequel le risque de confusion s’apprécie est consubstantielle de la protection des droits querellés dans ledit cadre. C’est l’application du principe de la territorialité des droits qui veut qu’un droit n’est garanti que dans les limites du territoire du pays dans lequel la protection a été acquise. Dès lors, il était récurrent que des personnes exploitant des marques se trouvent démunies de tout argument dans les pays où celles – ci avaient été abusivement déposées. L’application difficultueuse de ce principe a donné l’occasion à une doctrine relativement majoritaire d’envisager la consécration d’un autre principe à savoir celui de l’universalité. Cette règle suggère que, l’acquisition de droits sur la marque, par voie de dépôt ou d’usage dans un pays donné interdit à un tiers de s’approprier une telle marque dans le pays appliquant ce principe. Cette théorie a un inconvénient majeur qui réside dans la difficulté pratique d’effectuer les recherches internationales avant tout dépôt de marques. Acquis sous une législation consacrant l’universalité, le droit de propriété sur la marque souffrait donc d’une certaine fragilité. La solution semble avoir été trouvée en droit communautaire par la consécration de la supranationalité des droits de propriété industrielle. Cette consécration quoique très controversée a été réalisé en droit OAPI car on observe une survivance des titres nationaux à cotés desquels les droits nationaux demeurent valides. Sur ce point nous préconisons l’application du principe de la supranationalité selon le modèle de l’Union Européenne au sein de laquelle un droit est protégé indifféremment de l’Etat de l’Union dans lequel il a été acquis. Ce qui permet d’appréhender efficacement tout risque de confusion. Le juge camerounais, quant à lui, a déjà amorcé ce revirement dans une décision qui, nous l’espérons ne restera pas sans échos.
The Single-Seed Microbiota Reveals Rare Taxa-Associated Community Robustness
Authors: Kim Hyun , Kim Christopher , Lee Yong-Hwan
Published: March 2023

Genetic and environmental cues affecting seed microbial communities have been investigated to assess the ecological characteristics of seed microbial communities. However, little is known concerning seed-to-seed microbial variations and ecological drivers at the single-seed level. We report rare taxa-associated heterogeneity and robustness of seed bacterial and fungal communities in individual seeds using 63 pooled and 70 single-seed samples from a single field-grown rice plant. Ordination analyses showed that seed-to-seed variation patterns could be clustered according to the originating panicle branch. Bacterial–fungal associations and in silico extinction experiments demonstrated that rare taxa contribute to the connectivity and robustness of the associations. Null modeling-based statistical analysis revealed that the distribution of rare taxa is mainly governed by dispersal limitation, whereas the distribution of prevalent taxa is mainly governed by homogeneous selection and ecological drift. Our findings provide an ecological framework for understanding the heterogeneity of seed microbial communities in a single plant; they will facilitate the development and application of seed microbiota or single microbe-based engineering strategies.
The Use of Wide-Awake Local Anesthesia No Tourniquet (WALANT) Technique for Distal Fibula Hardware Removal
Authors: Sabaghzadeh Amir , Biglari Farsad , Ebrahimpour Adel , Khavari Ardestani Davood , Sadighi Mehrdad , Jafari Kafiabadi Meisam
Published: March 2023

Ankle fracture is one of the most common fractures that are mainly treated with open reduction and internal fixation. Wide-awake local anesthesia no tourniquet (WALANT) technique has been widely used for hand and wrist surgeries, this method has been scarcely utilized in ankle surgery. To the best of our knowledge, only one study has evaluated the safety and efficacy of the WALANT technique in distal fibula hardware removal surgeries. This study aimed to investigate the result of using the WALANT technique in distal fibula hardware removal surgery. From April 2020 until March 2021 randomized clinical trial was performed on 60 patients between the ages of 18 and 60 years in our educational orthopedic center. In group A, an anesthesiologist administered spinal anesthesia and in group B the WALANT technique was used for anesthesia. The results of the current study showed that the visual analog scale in group B a day after the surgery was significantly lower, in comparison to group A. The outcome of our study demonstrated lesser blood loss in patients operated under the WALANT. This finding could be related to the vasoconstrictive properties of epinephrine used in the WALANT solution. Our findings suggest that the WALANT technique application in the proper setting and appropriate patient selection could lead to reduced postoperative pain, minimal bleeding, and shorter admission time. Other advantages include the simplicity and safety of the technique, it is being time and cost-effective.

Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Prognostic Value of Frailty for Heart Failure Patients Undergoing Left Ventricular Assist Device Implantation: A Systematic Review
Authors: Meece Lauren E. , Yu Julia , Winchester David E. , Petersen Matthew , Jeng Eric I. , Al-Ani Mohammad A. , Parker Alex M. , Vilaro Juan R. , Aranda Juan M. , Ahmed Mustafa M.
Published: March 2023

Frailty is associated with poor clinical outcomes in heart failure patients. The impact of frailty on outcomes following left ventricular assist device (LVAD) implantation, however, is less clearly defined. We therefore sought to conduct a systematic review to evaluate current frailty assessment strategies and their significance for patients undergoing LVAD implantation. We conducted a comprehensive electronic search of PubMed, Embase, and CINAHL databases from inception until April 2021 for studies examining frailty in patients undergoing LVAD implantation. Study characteristics, patient demographics, type of frailty measurement, and outcomes were extracted. Outcomes were organized into 5 basic categories: implant length of stay (iLOS), 1-year mortality, rehospitalization, adverse events, and quality of life (QOL). Of the 260 records retrieved, 23 studies involving 4935 patients satisfied the inclusion criteria. Approaches to measuring frailty varied, with the 2 most common being sarcopenia determined by computed tomography and Fried’s frailty phenotype assessment. Outcomes of interest were also widely variable, with iLOS stay and mortality being the most frequently reported, albeit with differing definitions of both between studies. The heterogeneity among included studies precluded quantitative synthesis. Narrative synthesis showed that frailty by any measure is more likely to be associated with higher mortality, longer iLOS, more adverse events and worse QOL post-LVAD implant. Frailty can be a valuable prognostic indicator in patients undergoing LVAD implantation. Further studies are needed to determine the most sensitive frailty assessment, as well as the ways in which frailty may serve as a modifiable target to improve outcomes following LVAD implantation.
Radon-222 and Leukemia
Authors: Harley Naomi H. , Leslie Lori A.
Published: March 2023

Leukemia was the first medically observed human cancer related to ionizing radiation in the 1945 follow-up study of atomic bomb survivors. The bone exposure and dose calculated here are based on the measured solubility of the noble gas 222Rn in blood. A fraction of the 222Rn gas in blood distributes as dissolved gas to all organs, with the fraction depending upon the blood flow rate to the organ. The exposure and dose calculated are for men and women based on measurements made for the blood flow rate to the femur, the largest bone in the human skeleton. The annual exposure and dose estimated for continuous 222Rn inhalation of 100 Bq m−3 are very low and unlikely to cause leukemia. Other neurological issues, from lifetime exposure to low activity concentrations of 222Rn alpha particle exposure in bone, are unknown.
Investigation of the Role of Cognitive Emotion Regulation Strategies on Depressive Symptoms in Mothers of Children Given A Diagnosis of Cancer
Authors: Tör Nurdağ Fazilet , Şengün Ïnan Figen
Published: March 2023

Background

The role of cognitive emotion regulation on depressive symptoms in mothers of children given a diagnosis of cancer is not yet well understood.

Objective

The aim of this study was to investigate the effect of cognitive emotion regulation strategies on depressive symptoms in mothers of children with cancer.

Methods

This study was conducted with a cross-sectional correlational design. The study included 129 participants. Participants completed the sociodemographic characteristics form, Beck Depression Inventory, and Cognitive Emotion Regulation Questionnaire. Hierarchical regression analysis was performed to determine the effect of cognitive emotion regulation strategies on depressive symptoms.

Results

Hierarchical multiple regression revealed that depressive symptoms were independently associated with self-blame (β = 0.279, P = .001) and catastrophizing (β = 0.244, P = .003) after controlling for sociodemographic characteristics of mothers. Emotion regulation strategies explained approximately 39.9% of the variance in depressive symptoms.

Conclusion

The results of the study indicate that more frequent engagement of self-blame and catastrophizing were associated with more depressive symptoms.

Implications for Practice

Nurses should screen mothers of children with cancer for depressive symptoms and identify mothers of children with cancer who use maladaptive cognitive emotion regulation strategies, such as self-blame and catastrophizing, as a risk group. Furthermore, nurses need to be involved in developing psychosocial interventions including adaptive cognitive emotion regulation strategies to help mothers coping with adverse emotions during a childhood cancer journey.
Symptom Patterning Across the Cancer Care Trajectory for Patients Receiving Chemoradiation for Head and Neck Cancer
Authors: Dunnack Yackel Hayley , Xu Wanli , Lee Jung Wun , Cong Xiaomei , Salner Andrew , Duffy Valerie B. , Judge Michelle P.
Published: March 2023

Background

Patients with head and neck cancer (HNC) experience a multitude of symptoms because of the tumor and its treatment.

Objective

To identify the symptom patterns present in cancer treatment and survivorship periods for patients with HNC using latent class analysis.

Methods

A retrospective longitudinal chart review was conducted to examine symptoms reported by patients who received concurrent chemoradiation for HNC in a regional Northeastern United States cancer institute. Latent class analysis was performed to identify the latent classes present across multiple timepoints during treatment and survivorship for the most commonly reported symptoms.

Results

In 275 patients with HNC, the latent transition analysis revealed 3 latent classes for both treatment and survivorship periods: (1) mild, (2) moderate, and (3) severe symptoms. Patients were more likely to report a greater number of symptoms in a more severe latent class. During treatment, moderate and severe classes had representation of all most common symptoms: pain, mucositis, taste alterations, xerostomia, dysphagia, and fatigue. Different symptom patterns emerged for survivorship, with prominence of taste alterations and xerostomia across all classes, and all symptoms present in the severe class. The probability of symptom expression varied more in the survivorship period compared with the treatment period.

Conclusions

Patients reported numerous symptoms during active treatment persisting into survivorship. Patients tended to transition to more severe symptomatology as treatment progressed and to more moderate symptomatology as survivorship evolved.

Implications for Practice

Examining the trend of persistent moderate symptomatology into survivorship is useful to optimize symptom management.
Dementias Among Older Males and Females in the U.S. Medicare System With and Without HIV
Authors: Yu Xiaoying , Kuo Yong-Fang , Raji Mukaila A. , Berenson Abbey B. , Baillargeon Jacques , Giordano Thomas P.
Published: March 2023

Background:

Despite the growing concern that people with HIV (PWH) will experience a disproportionate burden of dementia as they age, very few studies have examined the sex-specific prevalence of dementia, including Alzheimer disease and related dementias (AD/ADRD) among older PWH versus people without HIV (PWOH) using large national samples.

Methods:

We constructed successive cross-sectional cohorts including all PWH aged 65+ years from U.S. Medicare enrollees and PWOH in a 5% national sample of Medicare data from 2007 to 2019. All AD/ADRD cases were identified by ICD-9-CM/ICD-10-CM diagnosis codes. Prevalence of AD/ADRD was calculated for each calendar year by sex–age strata. Generalized estimating equations were used to assess factors associated with dementia and calculate the adjusted prevalence.

Results:

PWH had a higher prevalence of AD/ADRD, which increased over time compared with PWOH, especially among female beneficiaries and with increasing age. For example, among those aged 80+ years, the prevalence increased from 2007 to 2019 (females with HIV: 31.4%–44.1%; females without HIV: 27.4%–29.9%; males with HIV: 26.2%–33.3%; males without HIV: 21.0%–23.5%). After adjustment for demographics and comorbidities, the differences in dementia burden by HIV status remained, especially among older age groups.

Conclusions:

Older Medicare enrollees with HIV had an increased dementia burden over time compared with those without HIV, especially women and older subjects. This underscores the need to develop tailored clinical practice guidelines that facilitate the integration of dementia and comorbidity screening, evaluation, and management into the routine primary care of aging PWH.
Assessment of Cardiovascular Disease Among Predominantly Black Gout Patients
Authors: Chandrakumar Harshith Priyan , Puskoor Anoop Venkat , Chillumuntala Seeta , Sharif Sara , Mora Diego Cepeda , Gupta Tanuj , Tadayoni Ashkan , Zonnoor Seyedeh Leila , Celiker Pelin , Yakoubovitch Stephanie , Tsai Andrew , Chiu Courtney , Kazi Anan , Freilich Michael , Saleh Ahmad , Moon Seung Jae , Cruickshank Kingsley , Li Shuojohn , Katz Julie , Eichler Joanna , Salciccioli Louis , McFarlane Isabel M.
Published: March 2023

Introduction

Although the association between gout and cardiovascular disease (CVD) has been extensively studied, scarce data are available for the Black population. We aimed to assess the association between gout and CVD in a predominantly Black urban population with gout.

Methods

A cross-sectional analysis was performed between a gout cohort and an age-/sex-matched control group. Clinical parameters and 2D echocardiograms were reviewed for the patients with gout and heart failure (HF). The primary outcome studied includes the prevalence and strength of association between gout and CVD. Secondary outcomes studied includes strength of association of gout and HF categorized by ejection fraction, mortality, and HF readmissions.

Results

Four hundred seventy-one patients with gout had a mean age of 63.7 ± 0.5 years; 89% were Black, 63% were men, and mean body mass index was 31.3 ± 0.4 kg/m2. Hypertension, diabetes mellitus, and dyslipidemia were present in 89%, 46%, and 52%, respectively. Compared with controls, patients with gout had significantly higher rates of angina, arrhythmia, coronary artery disease/stents, myocardial infarction, coronary artery bypass graft surgery, cerebrovascular accident, and peripheral vascular disease. The adjusted odds ratio for CVD was 2.9 (95% confidence interval, 1.9–4.5; p < 0.001). Gout patients had a higher prevalence of HF with 45% (n = 212) compared with controls with 9.4% (n = 44). Adjusted odds ratio for HF risk was 7.1 (95% confidence interval, 4.7–10.6; p < 0.01).

Conclusions

Gout in a predominantly Black population confers 3 times the CVD risk and 7 times HF-specific risk compared with age- and sex-matched cohort. Further research is needed to confirm our findings and to develop interventions to reduce morbidity associated with gout.
Frequency of Helicobacter pylori in Patients With Rheumatoid Arthritis Whose Methotrexate Was Stopped Due to Gastrointestinal Intolerance
Authors: Aydemir Guloksuz Emine Gozde , Sezer Serdar , Yayla Mucteba Enes , Sahin Eroglu Didem , Uslu Yurteri Emine , Kelesoglu Dincer Ayse Bahar , Torgutalp Murat , Yuksel Mehmet Levent , Okatan Ilyas Ercan , Gumussoy Mesut , Yilmaz Recep , Ilbay Ahmet , Soykan Arif Irfan , Ates Askin , Turgay Tahsin Murat , Kinikli Gulay
Published: March 2023

Objective

The aims of this study were to compare the frequency of Helicobacter pylori between patients with rheumatoid arthritis (RA) with and without methotrexate (MTX)–related gastrointestinal system (GIS) intolerance, and to demonstrate the associated factors with such intolerance.

Methods

The data of 9756 patients with RA who presented between January 2011 and December 2020 were evaluated. Methotrexate-related GIS intolerance was defined as the discontinuation of MTX owing to the dyspeptic symptoms despite supportive measures and was detected in 1742 (31.3%) patients among 5572 MTX users. A total of 390 patients with and without intolerance who had at least 1 gastroscopic evaluation were included in the final analyses. The demographic, clinical, laboratory, and pathologic characteristics of patients with and without MTX-related GIS intolerance were compared. To determine the associated factors with MTX-related GIS intolerance, logistic regression analysis was performed.

Results

Of 390 patients, 160 (41.0%) patients had MTX-related GIS intolerance. According to the pathology results, the presence of H. pylori, inflammation, and activity were significantly higher in patients with MTX-related GIS intolerance (p < 0.001 for each comparison). In multivariable logistic regression analysis, the use of biologic disease-modifying antirheumatic drugs (DMARDs) or targeted synthetic DMARDs was found to be an independently associated factor for MTX-related GIS intolerance (odds ratio [OR], 3.03 for model 1; OR, 3.02 for model 2) in addition to H. pylori presence (OR, 9.13 for model 1; OR, 5.71 for model 2).

Conclusions

In this study, we found that the presence of H. pylori and the use of biologic or targeted synthetic DMARDs were associated with MTX-related GIS intolerance.
Childhood-Onset Sacroiliitis
Authors: Avar-Aydin Pinar Ozge , Ozcakar Zeynep Birsin , Kaynak Sahap Seda , Aydin Fatma , Cakar Nilgun , Arslanoglu Ceyda , Yalcinkaya Fatos , Fitoz Suat
Published: March 2023

Objective

The aims of this study were to describe disease associations of magnetic resonance imaging (MRI)–confirmed and clinically symptomatic sacroiliitis in pediatric patients with rheumatic diseases and to examine the relationship between patient characteristics and MRI findings of the sacroiliac joint (SIJ).

Methods

Demographic and clinical data were extracted from the electronic medical records of the patients with sacroiliitis followed in the last 5 years. Active inflammatory and structural damage lesions of the SIJ-MRI were examined by the modified Spondyloarthritis Research Consortium of Canada scoring system, and correlation analysis of these results with clinical characteristics was evaluated.

Results

A total of 46 symptomatic patients were found to have MRI-proven sacroiliitis of 3 different etiologies: juvenile idiopathic arthritis (JIA) (n = 17), familial Mediterranean fever (FMF) (n = 14), and chronic nonbacterial osteomyelitis (CNO) (n = 8). Seven patients, FMF and JIA (n = 6) and FMF and CNO (n = 1), had a co-diagnosis that might cause sacroiliitis. Although inflammation scores and structural damage lesions did not statistically differ between the groups, capsulitis and enthesitis on the MRI were more frequently detected in the CNO group. There was a negative correlation between symptom onset and inflammation scores of bone marrow edema. Disease composite scores and acute phase reactants were correlated with MRI inflammation scores.

Conclusions

We demonstrated that JIA, FMF, and CNO were the major rheumatic causes of sacroiliitis in children originating from the Mediterranean region. Quantitative MRI scoring tools can be used to assess the inflammation and damage of the SIJ in rheumatic diseases, show discrepancies between them, and have an important correlation with various clinical and laboratory features.
68Ga-FAPI04 Versus 68Ga-DOTATATE PET/CT in a Patient With Multiple Meningioma
Authors: Denizmen Dilara , Isik Emine Goknur , Buyukkaya Fikret , Kuyumcu Serkan
Published: March 2023

We present the 68Ga-DOTATATE and 68Ga-FAPI (fibroblast activation protein inhibitor) PET/CT findings of a 61-year-old man diagnosed with atypical World Health Organization grade II multiple meningiomas. The patient has been stable for 2 years following multiple surgeries and external radiotherapy because of recurring disease until he recently described frequent headaches, and a follow-up examination confirmed new meningioma lesions on MRI. However, the patient was inoperable and was referred for 68Ga-DOTATATE PET/CT to determine eligibility for salvage peptide receptor radionuclide therapy. He also underwent fibroblast activation protein–targeted imaging using 68Ga-FAPI04 PET/CT, which revealed heterogeneous, low to mild fibroblast activation protein expression across multiple meningioma lesions.
Modified Frailty Index Identifies Increased Risk of Postoperative Complications in Geriatric Patients After Open Reduction Internal Fixation for Distal Radius and Ulna Fractures
Authors: Dave Dattesh R. , Zeiderman Matthew , Li Andrew I. , Pereira Clifford
Published: March 2023

Background

Open reduction internal fixation (ORIF) of distal radius and ulnar fractures (DRUFs) is one of the most common fracture surgeries for hand surgeons. Few studies have evaluated how frailty contributes to outcomes in geriatric hand surgery patients. This study hypothesizes that geriatric patients scoring higher on the modified Frailty Index 5 (mFI-5) are at greater risk of postoperative complications following DRUF fixation.

Methods

The American College of Surgeons National Surgical Quality Improvement Project database was reviewed for ORIF for DRUFs from 2005 to 2017. Statistically significant differences for demographics, comorbidities, mFI-5, and postoperative complications between geriatric and nongeriatric patients were evaluated with multivariate logistic regression analysis.

Results

A total of 17,097 ORIF for DRUFs were collected by the National Surgical Quality Improvement Project 2005–2017, with 5654 patients older than 64 years (33.2%). Average age for geriatric patients undergoing ORIF for DRUFs was 73.7 years. Within geriatric patients, an mFI-5 score >2 confers 1.6-times increased risk of returning to the operating room following ORIF for DRUF (adjusted odds ratio, 1.6; P = 0.02), whereas an increase in mFI-5 score >2 confers a 3.2-times increased risk of deep vein thrombosis among geriatrics (adjusted odds ratio, 3.2 P < 048).

Conclusion

Frailty among geriatric patients confers increased risk of deep vein thrombosis postoperatively. Geriatric patients with higher frailty scores carry a significantly increased risk of returning to the operating room within 30 days. Hand surgeons can use the mFI-5 to screen geriatric patients with DRUF patients to guide perioperative decision-making.
Mechanisms and Treatments of Peripheral Nerve Injury
Authors: Liu Xiaoyu , Duan Xuchu
Published: March 2023

Peripheral nerve injury is a common injury disease. Understanding of the mechanisms of periphery nerve repair and regeneration after injury is an essential prerequisite for treating related diseases. Although the biological mechanisms of peripheral nerve injury and regeneration have been studied comprehensively, the clinical treatment methods are still limited. The bottlenecks of the treatments are the shortage of donor nerves and the limited surgical precision. Apart from the knowledge regarding the fundamental characteristics and physical processes of peripheral nerve injury, numerous studies have found that Schwann cells, growth factors, and extracellular matrix are main factors affecting the repair and regeneration process of injured nerves. At present, the therapeutical methods of the disease include microsurgery, autologous nerve transplantation, allograft nerve transplantation and tissue engineering technology. Tissue engineering technology, which combines seed cells, neurotrophic factors, and scaffold materials together, is promising for treating the patients with long-gapped and large nerve damage. With the development of neuron science and technology, the treatment of peripheral nerve injury diseases will continue being improved.
Prognostic Factors and Outcomes of Cutaneous Malignant Melanoma
Authors: Matrakool Piyawat , Chaisrisawadisuk Sarut , Vongviriyangkoon Tara
Published: March 2023

Background

Malignant melanoma is a common skin cancer among Asians. However, some features, such as tumor type and initial stages, are not comparable with those found in Western countries. We audited a large cohort of patients at a single tertiary referral hospital in Thailand to identify factors affecting the prognosis.

Methods

A retrospective study was conducted of patients diagnosed with cutaneous malignant melanoma between 2005 and 2019. Details of demographic data, clinical characteristics, pathological reports, treatments, and outcomes were collected. Statistical analyses of overall survival and factors affecting survival were investigated.

Results

The study enrolled 174 patients (79 men and 95 women) with pathologically confirmed cutaneous malignant melanoma. Their mean age was 63 years. The most common clinical presentation was a pigmented lesion (40.8%), with the plantar area being the most common site (25.9%). The mean duration of onset and hospitalization was 17.5 months. The 3 most common types of melanoma were acral lentiginous (50.7%), nodular (28.9%), and superficial spreading (9.9%). Eighty-eight cases (50.6%) had concomitant ulceration. Pathological stage III was the most common (42.1%). The 5-year overall survival was 43%, and the median survival time was 3.91 years. Multivariate analysis showed that clinically palpable lymph nodes, distant metastasis, a Breslow thickness ≥ 2 mm, and evidence of lymphovascular invasion were poor prognostic factors for overall survival.

Conclusions

In our study, most patients with cutaneous melanoma presented with a higher pathological stage. Independent factors affecting survival are palpable lymph nodes, distant metastases, Breslow thickness, and the presence of lymphovascular invasion. The overall 5-year survival rate was 43%.
The Medical Student Race to Research
Authors: Maisner Rose S. , Patel Ishani , Cadwell Joshua B. , Song Amy , Ong Melody , Goydos Christopher , Subramanian Shyamala , Kapadia Kailash , Lee Edward S.
Published: March 2023

Background

Abstract presentations increase research output and facilitate networking for medical students applying to plastic surgery. We aim to determine predictors of increased medical student presentation at national plastic surgery conferences, identifying disparities in access to research opportunities.

Methods

Abstracts presented at the 2 most recent meetings of the American Society of Plastic Surgeons, American Association of Plastic Surgeons, and Plastic Surgery Research Council were extracted from online archives. Presenters without MDs or other professional credentials were classified as medical students. Presenter gender, medical school ranking, plastic surgery division/department, National Institutes of Health funding, number of total and first-author publications, H-index, and research fellowship completion status were recorded. Students with 3 or more (>75th percentile) presentations were compared with those with less by χ
2 tests. Univariate and multivariable regressions identified factors associated with 3 or more presentations.

Results

Of 1576 abstracts, 549 (34.8%) were presented by 314 students. The gender distribution was 46.5% male and 53.5% female. Most were from the Northeast (36.9%), 35% came from top 20 medical schools, and 85% attended schools with home plastic surgery programs. While 61.8% presented once, 14.6% presented 3 or more times. Those who previously presented, completed research fellowships or had more publications or higher H-indices were likely to present more (P ≤ 0.007). On multivariable-adjusted analysis, completing research fellowships (odds ratio [OR], 2.34–2.52; P = 0.028–0.045), affiliation with institutions having higher National Institutes of Health funding (OR, 3.47–3.73; P = 0.004–0.006), or having more total number of publications (OR, 3.81; P = 0.018) or first-author publications (OR, 3.84; P = 0.008) was associated with 3 or more presentations. Presenter gender, geographic region, medical school ranking, home program status, and H-indices were not significant predictors on multivariable analysis.

Conclusions

There are several potential inequities in access to research opportunities for medical students, disadvantaging those with less well-funded plastic surgery programs and existing research experience. Improving the equitability of these opportunities is crucial for limiting bias in trainee recruitment and diversifying representation in the field.