bluuebunny/crossref_metadata_2025 huggingface dataset:
Ambulatory blood pressure trajectories and blood pressure variability in kidney transplant recipients: a comparative study against haemodialysis patients
Authors: Korogiannou Maria , Sarafidis Pantelis , Alexandrou Maria Eleni , Theodorakopoulou Marieta P , Pella Eva , Xagas Efstathios , Argyris Antonis , Protogerou Athanase , Papagianni Aikaterini , Boletis Ioannis N , Marinaki Smaragdi
Published: December 2021

Background

Hypertension is the most prevalent cardiovascular risk factor in kidney transplant recipients (KTRs). Preliminary data suggest similar ambulatory blood pressure (BP) levels in KTRs and haemodialysis (HD) patients. This is the first study comparing the full ambulatory BP profile and short-term BP variability (BPV) in KTRs versus HD patients.

Methods

A total of 204 KTRs were matched (2:1 ratio) with 102 HD patients for age and gender. BP levels, BP trajectories and BPV indices over a 24-h ambulatory BP monitoring (ABPM) in KTRs were compared against both the first and second 24-h periods of a standard 48-h ABPM in HD patients. To evaluate the effect of renal replacement treatment and time on ambulatory BP levels, a two-way ANOVA for repeated measurements was performed.

Results

KTRs had significantly lower systolic blood pressure (SBP) and pulse-pressure (PP) levels compared with HD patients during all periods studied (24-h SBP: KTR: 126.5 ± 12.1 mmHg; HD first 24 h: 132.0 ± 18.1 mmHg; P = 0.006; second 24 h: 134.3 ± 17.7 mmHg; P < 0.001); no significant differences were noted for diastolic blood pressure levels with the exception of the second nighttime. Repeated measurements ANOVA showed a significant effect of renal replacement therapy modality and time on ambulatory SBP levels during all periods studied, and a significant interaction between them; the greatest between-group difference in BP (KTRs–HD in mmHg) was observed at the end of the second 24 h [–13.9 mmHg (95% confidence interval –21.5 to –6.2); P < 0.001]. Ambulatory systolic and diastolic BPV indices were significantly lower in KTRs than in HD patients during all periods studied (24-h SBP average real variability: KTRs: 9.6 ± 2.3 mmHg; HD first 24 h: 10.3 ± 3.0 mmHg; P = 0.032; second 24 h: 11.5 ± 3.0 mmHg; P < 0.001). No differences were noted in dipping pattern between the two groups.

Conclusions

SBP and PP levels and trajectories, and BPV were significantly lower in KTRs compared with age- and gender-matched HD patients during all periods studied. These findings suggest a more favourable ambulatory BP profile in KTRs, in contrast to previous observations.
A multibranch, multitarget neural network for rapid point-source inversion in a microseismic environment: examples from the Hengill Geothermal Field, Iceland
Authors: Nooshiri Nima , Bean Christopher J , Dahm Torsten , Grigoli Francesco , Kristjánsdóttir Sigríður , Obermann Anne , Wiemer Stefan
Published: December 2021

Despite advanced seismological techniques, automatic source characterization for microseismic earthquakes remains difficult and challenging since current inversion and modelling of high-frequency signals are complex and time consuming. For real-time applications such as induced seismicity monitoring, the application of standard methods is often not fast enough for true complete real-time information on seismic sources. In this paper, we present an alternative approach based on recent advances in deep learning for rapid source-parameter estimation of microseismic earthquakes. The seismic inversion is represented in compact form by two convolutional neural networks, with individual feature extraction, and a fully connected neural network, for feature aggregation, to simultaneously obtain full moment tensor and spatial location of microseismic sources. Specifically, a multibranch neural network algorithm is trained to encapsulate the information about the relationship between seismic waveforms and underlying point-source mechanisms and locations. The learning-based model allows rapid inversion (within a fraction of second) once input data are available. A key advantage of the algorithm is that it can be trained using synthetic seismic data only, so it is directly applicable to scenarios where there are insufficient real data for training. Moreover, we find that the method is robust with respect to perturbations such as observational noise and data incompleteness (missing stations). We apply the new approach on synthesized and example recorded small magnitude (M ≤ 1.6) earthquakes at the Hellisheiði geothermal field in the Hengill area, Iceland. For the examined events, the model achieves excellent performance and shows very good agreement with the inverted solutions determined through standard methodology. In this study, we seek to demonstrate that this approach is viable for microseismicity real-time estimation of source parameters and can be integrated into advanced decision-support tools for controlling induced seismicity.
Assessment of cerebral spinal fluid biomarkers and microRNA-mediated disease mechanisms in spinal muscular atrophy patient samples
Authors: Welby Emily , Rehborg Rebecca J , Harmelink Matthew , Ebert Allison D
Published: December 2021

Cerebral spinal fluid (CSF) is a promising biospecimen for the detection of central nervous system biomarkers to monitor therapeutic efficacy at the cellular level in neurological diseases. Spinal muscular atrophy (SMA) patients receiving intrathecal antisense oligonucleotide (nusinersen) therapy tend to show improved motor function, but the treatment effect on cellular health remains unknown. The objective of this study was to assess the potential of extracellular RNAs and microRNAs in SMA patient CSF as indicators of neuron and glial health following nusinersen treatment. Extracellular RNA analysis of CSF samples revealed ongoing cellular stress related to inflammation and glial differentiation, even after treatment administration. Downregulated microRNA expression associated with SMA-specific or general motor neuron dysfunction in animal and cellular models, tended to increase in nusinersen-treated patient CSF samples and correlated with SMA Type 1 and 2 motor functioning improvements. However, miR-146a, known to be upregulated in SMA-induced pluripotent stem cell (iPSC)-derived astrocytes, showed increased expression in nusinersen-treated CSF samples. We then used mRNA sequencing and multi-electrode arrays to assess the transcriptional and functional effects of miR-146a on healthy and SMA iPSC-derived motor neurons. miR-146a treatment on iPSC-derived motor neurons led to a downregulation of extracellular matrix genes associated with synaptic perineuronal net and alterations in spontaneous electrophysiological activity. Altogether, this study suggests that extracellular RNAs and microRNAs may serve as useful biomarkers to monitor cellular health during nusinersen treatment. Moreover, these data highlight the importance of addressing astrocyte health and response to nusinersen in SMA pathogenesis and treatment strategies.
County-level socio-economic disparities in COVID-19 mortality in the USA
Authors: Dukhovnov Denys , Barbieri Magali
Published: December 2021

Background

Preliminary studies have suggested a link between socio-economic characteristics and COVID-19 mortality. Such studies have been carried out on particular geographies within the USA or selective data that do not represent the complete experience for 2020.

Methods

We estimated COVID-19 mortality rates, number of years of life lost to SARS-CoV-2 and reduction in life expectancy during each of the three pandemic waves in 2020 for 3144 US counties grouped into five socio-economic status categories, using daily death data from the Johns Hopkins University of Medicine and weekly mortality age structure from the Centers for Disease Control.

Results

During March–May 2020, COVID-19 mortality was highest in the most socio-economically advantaged quintile of counties and lowest in the two most-disadvantaged quintiles. The pattern reversed during June–August and widened by September–December, such that COVID-19 mortality rates were 2.58 times higher in the bottom than in the top quintile of counties. Differences in the number of years of life lost followed a similar pattern, ultimately resulting in 1.002 (1.000, 1.004) million years in the middle quintile to 1.381 (1.378, 1.384) million years of life lost in the first (most-disadvantaged) quintile during the whole year.

Conclusions

Diverging trajectories of COVID-19 mortality among the poor and affluent counties indicated a progressively higher rate of loss of life among socio-economically disadvantaged communities. Accounting for socio-economic disparities when allocating resources to control the spread of the infection and to reinforce local public health infrastructure would reduce inequities in the mortality burden of the disease.
Chronic Consumer Liminality: Being Flexible in Precarious Times
Authors: Mimoun Laetitia , Bardhi Fleura
Published: December 2021

This study introduces the notion of chronic consumer liminality (CCL) defined as a recurrently activated state of transition experienced when engaging in frequent, multiple, and nonlinear consumer life transitions. CCL is characterized by (1) reoccurring transitions, (2) ongoing self-transformation, and (3) the embracing of precarity. We find evidence of CCL in a multimethod qualitative study of the flexible consumer lifestyle. CCL emerges as a response to the liquidification of society and the rise of a marketplace ideology of flexibility. CCL is manifested and managed through three CCL navigation processes: destabilizing consumption routines, liquidifying consumption, and asserting control over time and money. Thus, consumers experiencing CCL tend to prefer variety seeking and serendipity over routine even for mundane choices, access-based consumption across domains, and a productivity orientation toward free time. Three skills also facilitate CCL: resilient optimism, adaptability, and self-preservation. This study contributes to research on liminality, consumption in liminality, liquid consumption, and precarity. We conclude with the managerial implications of our framework.
A case of canalicular adenoma with anemia
Authors: Komatsu Yuko , Kawai Tadashi , Chiba Toshimi , Takeda Yasunori , Yamada Hiroyuki
Published: December 2021

An 81-year-old woman presented with bleeding from a soft elastic bulge on the right buccal mucosa. Her medical history included hypertension, chronic renal failure, hysterectomy and a goiter operation. Certain investigations, such as blood tests, which confirmed the minimum hemoglobin level of 5.3 g/dl, computed tomography and magnetic resonance imaging (MRI), were conducted. MRI revealed features confirming the presence of a tumor involving the right buccal mucosa with high signal in T2-enhanced image. Considering the provisional diagnosis and image findings, the tumor mass was excised and histopathological examination of the biopsy specimen confirmed the diagnosis of a canalicular adenoma. Under the diagnosis of various clinical departments, the anemic state of the patient might be chiefly attributed to the bleeding from the tumor. Herein, we report a rare case of a canalicular adenoma in the right buccal mucosa with anemia due to bleeding from the tumor.
A new look at local ultraluminous infrared galaxies: the atlas and radiative transfer models of their complex physics
Authors: Efstathiou A , Farrah D , Afonso J , Clements D L , González-Alfonso E , Lacy M , Oliver S , Papadopoulou Lesta V , Pearson C , Rigopoulou D , Rowan-Robinson M , Spoon H W W , Verma A , Wang L
Published: December 2021

We present the ultraviolet to submillimetre spectral energy distributions (SEDs) of the HERschel Ultra Luminous Infrared Galaxy Survey (HERUS) sample of 42 local ultraluminous infrared galaxies (ULIRGs) and fit them with a Markov chain Monte Carlo code using the CYprus models for Galaxies and their NUclear Spectra (CYGNUS) radiative transfer models for starbursts, active galactic nucleus (AGN) tori, and host galaxy. The Spitzer IRS spectroscopy data are included in the fitting. Our Bayesian SED fitting method takes comparable time to popular energy balance methods but it is more physically motivated and versatile. All HERUS galaxies harbour high rates of star formation but we also find bolometrically significant AGN in all of the galaxies of the sample. We estimate the correction of the luminosities of the AGN in the ULIRGs due to the anisotropic emission of the torus and find that it could be up to a factor of ∼10 for nearly edge-on tori. We present a comparison of our results with the smooth torus model of Fritz et al. and the two-phase models of Siebenmorgen et al. and SKIRTOR. We find that the CYGNUS AGN torus models fit significantly better the SEDs of our sample compared to all other models. We find no evidence that strong AGN appear either at the beginning or end of a starburst episode or that starbursts and AGN affect each other. IRAS 01003−2238 and Mrk 1014 show evidence of dual AGNs in their SED fits, suggesting a minimum dual AGN fraction in the sample of 5 per cent.
On the validity of steady-state for nebular phase kilonovae
Authors: Pognan Quentin , Jerkstrand Anders , Grumer Jon
Published: December 2021

The radioactively powered transient following a binary neutron star merger, known as a kilonova (KN), is expected to enter the steady-state nebular phase a few days after merger. Steady-state holds until thermal reprocessing time-scales become long, at which point the temperature and ionization states need to be evolved time-dependently. We study the onset and significance of time-dependent effects using the non-local thermodynamic equilibrium spectral synthesis code sumo. We employ a simple single-zone model with an elemental composition of Te, Ce, Pt, and Th, scaled to their respective solar abundances. The atomic data are generated using the Flexible Atomic Code (fac), and consist of energy levels and radiative transitions, including highly forbidden lines. We explore the KN evolution from 5 to 100 d after merger, varying ejecta mass and velocity. We also consider variations in the degree of electron magnetic field trapping, as well as radioactive power generation for alpha and beta decay (but omitting fission products). We find that the transition time, and magnitude of steady-state deviations are highly sensitive to these parameters. For typical KN ejecta, the deviations are minor within the time-frame studied. However, low density ejecta with low energy deposition show significant differences from ∼10 d. Important deviation of the ionization structure solution impacts the temperature by altering the overall line cooling. Adiabatic cooling becomes important at t ≥ 60 d which, in addition to the temperature and ionization effects, lead to the bolometric light-curve deviating from the instantaneous radioactive power deposited.
Chest computed tomography findings of adult patients with antimelanoma differentiation-associated protein 5 antibody-positive interstitial lung disease
Authors: Waseda Yuko , Johkoh Takeshi , Prosch Helmut , Nemec Stefan , Saeki Keigo , Watanabe Satoshi , Hamaguchi Yasuhito , Shiraki Akira , Muro Yoshinao , Yasui Masahide , Kasahara Kazuo , Herold Christian , Ishizuka Tamotsu
Published: December 2021

Objectives

Interstitial lung disease (ILD) associated with the antimelanoma differentiation-associated protein 5 (anti-MDA5) antibody is a rapidly progressive disease that requires timely, aggressive treatment. However, prompt diagnosis is difficult due to the longer time required for antibody detection. This study described the computed tomography (CT) findings of anti-MDA5 antibody-positive ILD (anti-MDA5-ILD).

Methods

CT findings of 20 patients (7 men, 13 women; mean age, 53.6 ± 13.5 years) with anti-MDA5-ILD were retrospectively reviewed. All patients had clinical diagnoses of dermatomyositis, and 14 patients presented with amyopathic findings.

Results

Bilateral ground-glass attenuation, air-space consolidation, and reticular shadows were observed in 20 (100%), 15 (75%), and 3 (15%) patients, respectively. The spread of air-space consolidation was 6.0 ± 5.6% (mean ± standard deviation). Univariate analysis revealed that high Krebs von den Lungen-6, high spread of consolidation, low partial pressure of oxygen, and low forced vital capacity were significant predictors for poor survival. The final radiological diagnoses were nonspecific interstitial pneumonia and organising pneumonia (OP) in 2 (10%) and 16 (80%) patients, respectively. Further, 30% of OP patients showed fibrosis.

Conclusion

The characteristic CT findings of patients with anti-MDA5-ILD were ground-glass attenuation, air-space consolidation, and less reticulation. These CT findings were compatible with those of OP.
Efficacy and safety of filgotinib in combination with methotrexate in Japanese patients with active rheumatoid arthritis who have an inadequate response to methotrexate: Subpopulation analyses of 24-week data of a global phase 3 study (FINCH 1)
Authors: Tanaka Yoshiya , Matsubara Tsukasa , Atsumi Tatsuya , Amano Koichi , Ishiguro Naoki , Sugiyama Eiji , Yamaoka Kunihiro , Combe Bernard G , Kivitz Alan J , Bae Sang-Cheol , Keystone Edward C , Nash Peter , Matzkies Franziska , Bartok Beatrix , Pechonkina Alena , Kondo Akira , Ye Lei , Guo Ying , Tasset Chantal , Sundy John S , Takeuchi Tsutomu
Published: December 2021

Objectives

Evaluate the efficacy and safety of the Janus kinase-1 inhibitor filgotinib in Japanese patients with rheumatoid arthritis (RA) and inadequate response to methotrexate (MTX).

Methods

Data from 147 Japanese patients in FINCH 1, a 52-week global Phase 3 study, were analysed up to 24 weeks. Patients received once-daily filgotinib 200 or 100 mg, biweekly adalimumab, or placebo, all with stable background MTX.

Results

In the Japanese population, American College of Rheumatology 20% response rates at Week 12 (primary endpoint) were 77.5%, 65.9%, 53.6%, and 36.8% for filgotinib 200 mg, filgotinib 100 mg, adalimumab, and placebo. Proportions of patients achieving Disease Activity Score with 28 joints <2.6 at Week 24: filgotinib 200 mg, 65.0%; filgotinib 100 mg, 51.2%; adalimumab, 42.9%; and placebo, 5.3%. Incidence rates of serious infections: filgotinib 200 mg, 2.5%; filgotinib 100 mg, 0%; adalimumab, 10.7%; and placebo, 5.3%. Treatment-emergent laboratory abnormalities Grade ≥3 occurred in five (12.5%) filgotinib 200 mg, three (7.3%) filgotinib 100 mg, one (3.6%) adalimumab, and no placebo patients. No deaths were reported among Japanese patients.

Conclusions

Filgotinib once daily combined with MTX was effective and generally safe and well tolerated up to Week 24 in Japanese patients with RA and inadequate response to MTX.
Impaired function of rDNA transcription initiation machinery leads to derepression of ribosomal genes with insertions of R2 retrotransposon
Authors: Fefelova Elena A , Pleshakova Irina M , Mikhaleva Elena A , Pirogov Sergei A , Poltorachenko Valentin A , Abramov Yuri A , Romashin Daniil D , Shatskikh Aleksei S , Blokh Roman S , Gvozdev Vladimir A , Klenov Mikhail S
Published: December 2021

Eukaryotic genomes harbor hundreds of rRNA genes, many of which are transcriptionally silent. However, little is known about selective regulation of individual rDNA units. In Drosophila melanogaster, some rDNA repeats contain insertions of the R2 retrotransposon, which is capable to be transcribed only as part of pre-rRNA molecules. rDNA units with R2 insertions are usually inactivated, although R2 expression may be beneficial in cells with decreased rDNA copy number. Here we found that R2-inserted rDNA units are enriched with HP1a and H3K9me3 repressive mark, whereas disruption of the heterochromatin components slightly affects their silencing in ovarian germ cells. Surprisingly, we observed a dramatic upregulation of R2-inserted rRNA genes in ovaries lacking Udd (Under-developed) or other subunits (TAF1b and TAF1c-like) of the SL1-like complex, which is homologues to mammalian Selective factor 1 (SL1) involved in rDNA transcription initiation. Derepression of rRNA genes with R2 insertions was accompanied by a reduction of H3K9me3 and HP1a enrichment. We suggest that the impairment of the SL1-like complex affects a mechanism of selective activation of intact rDNA units which competes with heterochromatin formation. We also propose that R2 derepression may serve as an adaptive response to compromised rRNA synthesis.
Traumatic Stress Disorders
Authors: Beck J. Gayle , Sloan Denise M.
Published: December 2021

The symptoms of posttraumatic stress disorder (PTSD) have long been recognized in medicine, history, literature, and philosophy. This chapter provides an introduction and overview to this handbook, focusing on the historical context that underlies current issues within the trauma literature. This handbook contains eight parts, focusing on classification and phenomenology; epidemiology and special populations; contributions from theory, assessment, prevention, and early intervention; treatment; and dissemination/implementation and ending with a chapter highlighting future directions. The historical underpinnings of each area are delineated, with attention to their linkage with current research. The hope for this revised edition of the Handbook of Traumatic Stress Disorders is to facilitate linkages among cross-cutting areas of study and clinical application, while providing concise, up-to-date reviews of current knowledge.
Plasticity of bud outgrowth varies at cauline and rosette nodes in Arabidopsis thaliana
Authors: Fichtner Franziska , Barbier Francois F , Kerr Stephanie C , Dudley Caitlin , Cubas Pilar , Turnbull Colin , Brewer Philip B , Beveridge Christine A
Published: December 2021

Shoot branching is a complex mechanism in which secondary shoots grow from buds that are initiated from meristems established in leaf axils. The model plant Arabidopsis (Arabidopsis thaliana) has a rosette leaf growth pattern in the vegetative stage. After flowering initiation, the main stem elongates with the top leaf primordia developing into cauline leaves. Meristems in Arabidopsis initiate in the axils of rosette or cauline leaves, giving rise to rosette or cauline buds, respectively. Plasticity in the process of shoot branching is regulated by resource and nutrient availability as well as by plant hormones. However, few studies have attempted to test whether cauline and rosette branching are subject to the same plasticity. Here, we addressed this question by phenotyping cauline and rosette branching in three Arabidopsis ecotypes and several Arabidopsis mutants with varied shoot architectures. Our results showed no negative correlation between cauline and rosette branch numbers in Arabidopsis, demonstrating that there is no tradeoff between cauline and rosette bud outgrowth. Through investigation of the altered branching pattern of flowering pathway mutants and Arabidopsis ecotypes grown in various photoperiods and light regimes, we further elucidated that the number of cauline branches is closely related to flowering time. The number of rosette branches has an enormous plasticity compared with cauline branches and is influenced by genetic background, flowering time, light intensity, and temperature. Our data reveal different levels of plasticity in the regulation of branching at rosette and cauline nodes, and promote a framework for future branching analyses.
On the Logicality of Truth
Authors: Fujimoto Kentaro
Published: December 2021

Deflationism about truth describes truth as a logical notion. In the present paper, I explore the implication of the alleged logicality of truth from the perspective of axiomatic theories of truth, and argue that the deflationist doctrine of the logicality of truth gives rise to two types of self-undermining arguments against deflationism, which I call the conservativeness argument from logicality and the topic-neutrality argument.
Competition Links and Stock Returns
Authors: Eisdorfer Assaf , Froot Kenneth , Ozik Gideon , Sadka Ronnie
Published: December 2021

This paper demonstrates that value-relevant information about a firm appearing in regulatory disclosures of other firms is overlooked by investors. Firms highly mentioned in the 10-K competition section of other firms tend to outperform with risk-adjusted returns of up to 9$\%$ annually. Outperformance is concentrated in firms whose competition references are made in the context of targeting rather than admiration. Consistent with investor inattention, abnormal returns stem from cross-sector competition mentions as well as firms with low-analyst coverage. Moreover, highly mentioned firms exhibit improved fundamentals in subsequent years, further signifying they are underpriced.
Comparison of treatment retention of originator vs biosimilar products in clinical rheumatology practice in Sweden
Authors: Di Giuseppe Daniela , Lindstrom Ulf , Bower Hannah , Delcoigne Bénédicte , Frisell Thomas , Chatzidionysiou Katerina , Sjöwall Christopher , Lindqvist Elisabet , Askling Johan
Published: December 2021

Objectives

To compare treatment retention between biosimilars and their originator products among first starters (etanercept, infliximab, adalimumab and rituximab), as well as after non-medical switch.

Methods

Patients with rheumatic diseases starting, for the first time, an originator or biosimilar etanercept, infliximab, adalimumab or rituximab were identified in the national Swedish Rheumatology Quality Register. Moreover, patients switching from an originator to its biosimilar were identified and individually matched to patients continuing on the originator. One-year treatment retention was calculated and hazard ratios (HR) for discontinuation with 95% CIs were estimated, adjusting for comorbidities and socio-economic factors.

Results

In total, 21 443 first treatment courses were identified. The proportion of patients still on the drug at 1 year and the HR for discontinuation revealed no differences across adalimumab (Humira, Imraldi, Amgevita and Hyrimoz) nor across rituximab products (Mabthera, Ritemvia/Truxima and Rixathon). The proportions on the drug at 1 year were similar for Benepali (77%) and Enbrel (75%) and the adjusted HR for Benepali compared with Enbrel was 0.91 (95% CI 0.83, 0.99). For infliximab, the proportion still on the drug at 1 year was 67% for Remicade and 66% for Remsima/Inflectra and the HR compared with Remicade was 1.16 (95% CI 1.02, 1.33). Among 2925 patients switching from an originator drug to one of its biosimilars, we noted no statistically significant or clinically relevant differences in drug survival compared with those who remained on originator therapy.

Conclusion

This large observational study supports the equivalence of biologic DMARD biosimilar products and originators when used in routine rheumatology care.
Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension
Authors: Taweel Helwa , Haddadin Ihab , Heresi Gustavo
Published: December 2021

Chronic thromboembolic pulmonary hypertension (CTEPH) remains significantly underdiagnosed in patients with a history of pulmonary embolism. These patients complain of persistent shortness of breath and present with hypoxemia despite proper anticoagulation. Further investigation reveals evidence of right ventricular dysfunction on echocardiogram, which progresses to right heart failure. CTEPH is associated with a significant increase in patient morbidity and mortality if left untreated. This article offers an approach for the timely recognition of this condition, in addition to suggesting a management protocol with an emphasis on the role of interventional radiology and balloon pulmonary angioplasty.
Impact of Mentoring on Academic Career Success for Women in Medicine: A Systematic Review
Authors: Shen Mary R. , Tzioumis Emma , Andersen Elizabeth , Wouk Kathryn , McCall Rebecca , Li Winston , Girdler Susan , Malloy Erin
Published: December 2021

Purpose

Research has shown that barriers to career success in academic medicine disproportionately affect women. These barriers include inadequate mentoring, which may perpetuate the underrepresentation of women in senior leadership positions. The purpose of this review was to summarize the qualitative and quantitative evidence of the impact of mentoring on women’s career outcomes and to inform future interventions to support the promotion and retention of women in academic medicine.

Method

The authors conducted a systematic review of original research published in English-language, peer-reviewed journals through March 20, 2020. Search terms related to mentorship, women, and academic medicine. The authors searched MEDLINE, Embase, Scopus, Current Contents Connect via Web of Science, Cochrane Library, and PsycINFO. They excluded studies not specifically addressing women and those without gender-stratified outcomes. They extracted and analyzed the following data: study design, population, sample size, response rate, participant age, percentage of women, mentoring prevalence, and outcomes.

Results

Of 2,439 citations identified, 91 studies met the inclusion criteria, including 65 quantitative and 26 qualitative studies. Mentoring was associated with objective and subjective measures of career success. Women perceived mentorship to be more valuable to their career development yet were more likely to report having no mentor. Additionally, women were more likely to report lower levels of research productivity, less career satisfaction, and greater barriers to promotion. Qualitative results indicated that women had less access to informal mentoring and family responsibilities had a greater effect on their career outcomes. Professional networking, female mentors, and relational aspects of mentoring were common themes.

Conclusions

This review examined gender disparities in mentoring and the impact on research productivity, promotion success, and career satisfaction for women in academic medicine. Institution-supported mentoring programs are needed to facilitate identification of appropriate mentors and promotion of a more equitable academic career environment for women.
Differential Item Functioning Analysis of United States Medical Licensing Examination Step 1 Items
Authors: Rubright Jonathan D. , Jodoin Michael , Woodward Stephanie , Barone Michael A.
Published: December 2021

Purpose

Previous studies have examined and identified demographic group score differences on United States Medical Licensing Examination (USMLE) Step examinations. It is necessary to explore potential etiologies of such differences to ensure fairness of examination use. Although score differences are largely explained by preceding academic variables, one potential concern is that item-level bias may be associated with remaining group score differences. The purpose of this 2019–2020 study was to statistically identify and qualitatively review USMLE Step 1 exam questions (items) using differential item functioning (DIF) methodology.

Method

Logistic regression DIF was used to identify and classify the effect size of DIF on Step 1 items meeting minimum sample size criteria. After using DIF to flag items statistically, subject matter expert (SME) review was used to identify potential reasons why items may have performed differently between racial and gender groups, including characteristics such as content, format, wording, context, or stimulus materials. USMLE SMEs reviewed items to identify the group difference they believed was present, if any; articulate a rationale behind the group difference; and determine whether that rationale would be considered construct relevant or construct irrelevant.

Results

All identified DIF rationales were relevant to the constructs being assessed and therefore did not reflect item bias. Where SME-generated rationales aligned with statistical differences (flags), they favored self-identified women on items tagged to women’s health content categories and were judged to be construct relevant.

Conclusions

This study did not find evidence to support the hypothesis that group-level performance differences beyond those explained by prior academic performance variables are driven by item-level bias. Health professions examination programs have an obligation to assess for group differences, and when present, investigate to what extent, if any, measurement bias plays a role.
Postoperative Management of Lung Transplant Recipients in the Intensive Care Unit
Authors: Di Nardo Matteo , Tikkanen Jussi , Husain Shahid , Singer Lianne G. , Cypel Marcelo , Ferguson Niall D. , Keshavjee Shaf , Del Sorbo Lorenzo
Published: December 2021

The number of lung transplantations is progressively increasing worldwide, providing new challenges to interprofessional teams and the intensive care units. The outcome of lung transplantation recipients is critically affected by a complex interplay of particular pathophysiologic conditions and risk factors, knowledge of which is fundamental to appropriately manage these patients during the early postoperative course. As high-grade evidence-based guidelines are not available, the authors aimed to provide an updated review of the postoperative management of lung transplantation recipients in the intensive care unit, which addresses six main areas: (1) management of mechanical ventilation, (2) fluid and hemodynamic management, (3) immunosuppressive therapies, (4) prevention and management of neurologic complications, (5) antimicrobial therapy, and (6) management of nutritional support and abdominal complications. The integrated care provided by a dedicated multidisciplinary team is key to optimize the complex postoperative management of lung transplantation recipients in the intensive care unit.
Gout and the COVID-19 pandemic
Authors: Tai Vicky , Robinson Philip C. , Dalbeth Nicola
Published: December 2021

Purpose of review

This review gives an overview of recently published articles on COVID-19 and gout.

Recent findings

People with gout are likely to be at an increased risk of poor outcomes after COVID-19 infection due to comorbid cardiometabolic conditions. The effects of chronic hyperuricemia on trained immunity, and the hyperinflammatory state induced by gout itself may also play a role. Frequent courses of glucocorticoids for gout flares may be associated with adverse outcomes after COVID-19 infection and reduced immunogenicity to the COVID-19 vaccination. Similarities between the pathophysiology of gout flares and the dysregulated inflammatory response of severe COVID-19 have been identified. Medications used in the treatment of gout, including colchicine and interleukin-1 inhibitors, have shown promise in the treatment of COVID-19 in clinical trials. Overall, the COVID-19 pandemic has had a negative impact on gout care, with patients reporting more difficulty with disease control, accessing medications and healthcare, and poorer quality of life.

The COVID-19 pandemic has created many challenges for people with gout. At present, there is a lack of guidance on the management of gout during the pandemic and paucity of research assessing outcomes of COVID-19 infection in people with gout.
Correlation between baropodometric parameters and functional evaluation in patients with surgically treated congenital idiopathic clubfoot
Authors: Castelo Luciano de A. , Saad Marcelo , Tamaoki Marcel J. S. , Dobashi Eiffel T. , Sodré Henrique
Published: December 2021

The study aimed to investigate the correlation between baropodometric parameters and the functional score in the evaluation of the results of surgery in patients with clubfoot. Fifty-one patients (77 feet) underwent surgical treatment, with a mean follow-up of 9.58 years (5–15 years), and a mean age of 10.2 years (7–16 years). A total of 39 males and 12 females were included, with 25 unilateral cases and 26 bilateral cases. The patients underwent a functional evaluation and an assessment of plantar pressure distribution using computerized baropodometry. The functional evaluation results were statistically analyzed to investigate any correlations. Unilateral and bilateral cases were studied in two different groups. The Mann–Whitney and Spearman correlation tests were used for these analyses. The static contact area, weight bearing time, gait speed, and plantar pressure peak were not correlated with the functional evaluation in the unilateral and bilateral cases. There was a statistically significant correlation (P < 0.05) among the integral plantar force, distribution of force, total plantar pressure, distance between the center of foot pressure and center of body mass, and dynamic contact area only in the bilateral cases. Baropodometry was correlated with the functional evaluation of several parameters in patients with bilateral involvement.
State-Level Masking Mandates and COVID-19 Outcomes in the United States
Authors: Wong Angus K. , Balzer Laura B.
Published: December 2021

Background:

We sought to investigate the effect of public masking mandates in US states on COVID-19 at the national level in Fall 2020. Specifically, we aimed to evaluate how the relative growth of COVID-19 cases and deaths would have differed if all states had issued a mandate to mask in public by 1 September 2020 versus if all states had delayed issuing such a mandate.

Methods:

We applied the Causal Roadmap, a formal framework for causal and statistical inference. We defined the outcome as the state-specific relative increase in cumulative cases and in cumulative deaths 21, 30, 45, and 60 days after 1 September. Despite the natural experiment occurring at the state-level, the causal effect of masking policies on COVID-19 outcomes was not identifiable. Nonetheless, we specified the target statistical parameter as the adjusted rate ratio (aRR): the expected outcome with early implementation divided by the expected outcome with delayed implementation, after adjusting for state-level confounders. To minimize strong estimation assumptions, primary analyses used targeted maximum likelihood estimation with Super Learner.

Results:

After 60 days and at a national level, early implementation was associated with a 9% reduction in new COVID-19 cases (aRR = 0.91 [95% CI = 0.88, 0.95]) and a 16% reduction in new COVID-19 deaths (aRR = 0.84 [95% CI = 0.76, 0.93]).

Conclusions:

Although lack of identifiability prohibited causal interpretations, application of the Causal Roadmap facilitated estimation and inference of statistical associations, providing timely answers to pressing questions in the COVID-19 response.
Clinical and Molecular Outcomes After Combined Intense Pulsed Light Therapy With Low-Level Light Therapy in Recalcitrant Evaporative Dry Eye Disease With Meibomian Gland Dysfunction
Authors: D'Souza Sharon , Padmanabhan Nair Archana , Iyappan Gowtham , Dickman Mor M. , Thakur Prashansa , Mullick Ritika , Kundu Gairik , Sethu Swaminathan , Ghosh Arkasubhra , Shetty Rohit
Published: December 2021

Purpose:

Dry eye disease (DED) is a leading cause of ocular morbidity worldwide. This study evaluates the effects of combined light therapy [intense pulsed light (IPL) and low-level light therapy (LLLT)] on clinical and molecular outcomes in evaporative DED with meibomian gland dysfunction (MGD).

Methods:

This prospective study evaluated 94 eyes (47 subjects) with chronic MGD treated with combined light therapy. Patients underwent a detailed evaluation of MGD and DED using the Ocular Surface Disease Index, dry eye tests—tear breakup time and Schirmer test, ocular surface staining, meibomian gland expressibility scoring, and meibography. Patients underwent a single session of combined light therapy (IPL + LLLT treatment) using the Eye-light device. All these tests were repeated at 3 and 6 months after treatment. Tear fluid and ocular surface wash samples were collected from a subset of patients before and after treatment for cellular and secreted immune factor profiling by flow cytometry.

Results:

Combined light therapy (IPL + LLLT) demonstrated a marked improvement in the clinical metrics studied. Three months after treatment, Ocular Surface Disease Index showed a significant reduction in 95.6% (P < 0.0001), tear breakup time increased in 72.3% (P < 0.0001), and meibomian gland expressibility scoring increased in 80.8% (P < 0.0001) of the eyes. These effects were observed to be sustained during the 6-month follow-up visit. Significant (P < 0.05) reduction in tear fluid levels of interleukin-1β, interleukin-17F, and MMP9; MMP9/TIMP1 ratio; and ocular surface B-cell proportions was observed.

Conclusions:

Combined light therapy shows promising results in patients with chronic MGD and DED, even in recalcitrant cases. Clinical and molecular factor alterations support the improved symptomatology and reduced inflammation.
The clinical impacts of molecular subtyping by multigene assay on hormone receptor-positive breast cancers
Authors: Liu Yeng-Ling , Hsu Chih-Yi , Feng Chin-Jung , Lien Pei-Ju , Huang Chi-Cheng , Lin Yen-Shu , Wang Yu-Ling , Chao Ta-Chung , Liu Chun-Yu , Chiu Jen-Hwey , Tsai Yi-Fang , Tseng Ling-Ming
Published: December 2021

Background:

Multigene assays, such as MammaPrint and BluePrint, provide additional information other than conventional immunohistochemistry (IHC) to help making decision of treatment. This study aims to compare the clinical correlation between molecular subtyping (MS) versus surrogate pathological subtyping (PS).

Methods:

A database from patients receiving MS evaluation in Taipei Veterans General Hospital from 2013 to 2018 was reviewed retrospectively. Patients were categorized as luminal A, luminal B, human epidermal growth factor receptor 2 (HER2) and basal type from MS results and also centrally assessed according to PS (estrogen receptor [ER], progesterone receptor [PgR], HER2, and Ki-67). The clinical correlation between two different subtyping methodologies was analyzed, and the application of chemotherapy was compared.

Results:

From 2013 to 2018, a total of 130 patients received MS testing in our institute, and 132 tumor samples were sent for analysis. From MammaPrint, 64 (48.5%) and 55 (41.7%) samples were defined as low and high risks, respectively. The other 13 (9.8%) tumor samples were identified as late recurrence low risk. MS restratified 44 tumors as subtype shifting including 20 tumors from A to B in intrinsic subtypes and 24 tumors from B to A after MS evaluation. Chemotherapy was conducted in only one (1.3%) patient with MS-luminal A but in 87.8% (n = 43) of MS-luminal B subtypes.

Conclusion:

The MS results restratify the subtypes of hormone receptor positive breast cancer and dominate decision-making of adjuvant therapy. The role of surrogate biomarkers as an alternative tool needs further elucidation. The treatment outcome in different subtypes categorized by MS or PS will be the interesting focus of research.
Safety and tolerability of regadenoson compared with dipyridamole in myocardial perfusion imaging in patients scheduled to undergo medium to high-risk noncardiac surgery: a randomized controlled study
Authors: Stavrou Petros Z. , Polytarchou Kali , Giannopoulou Chariklia , Pantos Kostas , Mourouzis Iordanis , Datseris Ioannis , Manolis Antonis S.
Published: December 2021

Objective

Regadenoson is the first Food and Drug Administration-approved selective A2A adenosine receptor agonist used in myocardial perfusion imaging. Its main benefits are its simplified and brief protocol, along with the ability to be administered safely in patients with asthma or chronic obstructive pulmonary disease of moderate severity. This study aims to identify any potential benefits of regadenoson, regarding the frequency of adverse reactions and its tolerability, over dipyridamole.

Methods

This is a randomized controlled study of 200 patients scheduled for medium to high-risk noncardiac surgery, of whom 100 were stressed with regadenoson (study group) and the rest with dipyridamole (control group).

Results

A greater proportion of adverse reactions was recorded in the regadenoson group as compared to the dipyridamole group (53 vs. 36%; P = 0.023), though the duration of most adverse reactions was shorter in the regadenoson group. Dyspnea (P < 0.001) and gastrointestinal disturbances (P = 0.001) were significantly more frequent in the regadenoson group. The use of aminophylline in patients who developed any adverse events was similar in the two groups (P > 0.05). When multiple regression analyses were performed, differences in adverse reactions between the two groups were no longer significant (odds ratio = 1.96; 95% confidence interval, 0.88–3.25; P = 0.11).

Conclusion

In our group of patients scheduled for myocardial perfusion imaging for preoperative assessment, the two agents, regadenoson and dipyridamole, have no significant differences in the frequency of mild adverse reactions and in aminophylline use, with regadenoson also having the advantage of faster symptom resolution. Nevertheless, dipyridamole can be considered as a well-tolerated and low-cost alternative.
Prediction of pathological response using 18F FDG PET/CT derived metabolic parameters in locally advanced breast cancer patients
Authors: Abd El-Gaid Salwa , AbdelHafez Marwa Nabil , Mohamed Ghada , Elazab Mohamed Samy Saied , Elahmadawy Mai Amr
Published: December 2021

Aim of work

This study aims to assess the value of flurodeoxyglucose (FDG)-PET derived metabolic parameters for prediction of pathologic response in LABC postneoadjuvant therapy.

Methods

Totally 47 patients with LABC underwent initial and postneoadjuvant therapy PET scans. ΔSUVmax%, ΔTLG% and ΔMTV% were calculated. Post-therapy histopathologic therapeutic response was assessed.

Results

In total 91.5% of patients had invasive duct carcinoma and the remaining (8.5%) had invasive lobular carcinoma. Postneoadjuvant PET/CT was able to detect 91.7% of patients with pathologically proven complete response in primary tumor, 69% of those with Pathologic partial response and 88.3% of those with pathological no response (P value <0.001). However, 40 out of the 47 patients had regional nodal metastases. PET/CT was able to predict 57.1% of the patients with pathologically nonresponding nodal deposits and 93.9% of those revealed pathologic therapeutic effect (P value <0.001). Receiver operating characteristic curve (ROC) curve marked Δ1ry SUVmax of 26.25% (P value 0.003), Δ1ry TLG of 48.5% (P value 0.018). PET and pathological response correlated well with ΔSUVmax%, and Δ1ry TLG% correlated well with PET, pathologic response and expression of HER II receptors (P value <0.001, 0.003 and 0.037 respectively). ROC curve marked ΔLN SUVmax% of 80.15% (P value 0.012), ΔLN TLG% of 86.6% (P value 0.002), whereas for ΔLN MTV% cut off point of 55% (P value 0.003). ΔSUVmax%, ΔTLG % and ΔMTV% for regional nodal metastases, were significantly correlated with PET (P values <0.001, <0.001 and 0.003, respectively) and pathologic (P values 0.018, 0.001 and 0.002, respectively) response.

Conclusion

FDG–PET is a useful tool for monitoring the neoadjuvant therapeutic effect for primary and regional nodes in patients with LABC.
Surgical Patient Compliance With Healthcare Facility–Provided In-home Opioid Disposal Products: A Systematic Review
Authors: Edwards John M. , Evans Hallie , Dollar Stace D. , Odom-Forren Jan , Johnson Bill
Published: December 2021

OBJECTIVE

The aim of this study was to review the literature regarding the use of an in-home opioid disposal product on unused opioids after surgery.

BACKGROUND

The opioid epidemic in the United States is a major cause of concern for healthcare facilities. The misuse and diversion of retained opioids after a surgical procedure continues to contribute to this problem.

METHODS

A comprehensive search of the Cumulative Index of Nursing and Allied Health Literature, OVID, and PubMed databases with keywords including opioid, analgesics, narcotics, medical waste disposal, medical disposal, refuse disposal, and opioid disposal resulted in 286 articles. Articles were screened based on strict inclusion and exclusion criteria.

RESULTS

Eight studies determined that an in-home opioid disposal product provided by a healthcare facility produced rates of opioid disposal between 19% and 71%.

CONCLUSIONS

The provision of an in-home opioid disposal product by a healthcare facility is likely to increase the disposal of unused opioid medications in the postoperative surgical patient population.