bluuebunny/crossref_metadata_2025 huggingface dataset:
Racial and Ethnic Inequities in Development of Type 2 Diabetes After Gestational Diabetes Mellitus
Authors: Janevic Teresa , McCarthy Katharine , Liu Shelley H. , Huyhn Mary , Kennedy Joseph , Tai Chan Hiu , Mayer Victoria L. , Vieira Luciana , Tabaei Bahman , Howell Frances , Howell Elizabeth , Van Wye Gretchen
Published: September 2023

OBJECTIVE:

To estimate racial and ethnic disparities in type 2 diabetes mellitus after gestational diabetes mellitus (GDM) and to investigate baseline pregnancy clinical and social or structural characteristics as mediators.

METHODS:

We conducted a retrospective cohort of individuals with GDM using linked 2009–2011 New York City birth and hospital data and 2009–2017 New York City A1c Registry data. We ascertained GDM and pregnancy characteristics from birth and hospital records. We classified type 2 diabetes as two hemoglobin A1c test results of 6.5% or higher. We grouped pregnancy characteristics into clinical (body mass index [BMI], chronic hypertension, gestational hypertension, preeclampsia, preterm delivery, caesarean, breastfeeding, macrosomia, shoulder dystocia) and social or structural (education, Medicaid insurance, prenatal care, and WIC [Special Supplemental Nutrition Program for Women, Infants, and Children] participation). We used Cox proportional hazards models to estimate associations between race and ethnicity and 8-year type 2 diabetes incidence, and we tested mediation of pregnancy characteristics, additionally adjusting for age and nativity (U.S.-born vs foreign-born).

RESULTS:

The analytic data set included 22,338 patients with GDM. The 8-year type 2 diabetes incidence was 11.7% overall and 18.5% in Black, 16.8% in South and Southeast Asian, 14.6% in Hispanic, 5.5% in East and Central Asian, and 5.4% in White individuals with adjusted hazard ratios of 4.0 (95% CI 2.4–3.9), 2.9 (95% CI 2.4–3.3), 3.3 (95% CI 2.7–4.2), and 1.0 (95% CI 0.9–1.4) for each group compared with White individuals. Clinical and social or structural pregnancy characteristics explained 9.3% and 23.8% of Black, 31.2% and 24.7% of Hispanic, and 7.6% and 16.3% of South and Southeast Asian compared with White disparities. Associations between education, Medicaid insurance, WIC participation, and BMI and type 2 diabetes incidence were more pronounced among White than Black, Hispanic, and South and Southeast Asian individuals.

CONCLUSION:

Population-based racial and ethnic inequities are substantial in type 2 diabetes after GDM. Characteristics at the time of delivery partially explain disparities, creating an opportunity to intervene on life-course cardiometabolic inequities, whereas weak associations of common social or structural measures and BMI in Black, Hispanic and South and Southeast Asian individuals demonstrate the need for greater understanding of how structural racism influences postpartum cardiometabolic risk in these groups.
Association Among Race, Ethnicity, Insurance Type, and Postpartum Permanent Contraception Fulfillment
Authors: Bullington Brooke W. , Berg Kristen A. , Miller Emily S. , Boozer Margaret , Serna Tania , Bailit Jennifer L. , Arora Kavita Shah
Published: September 2023

OBJECTIVE:

To evaluate the association among race, ethnicity, insurance type, and fulfillment of permanent contraception requests.

METHODS:

This is a secondary analysis of a retrospective cohort of patients who delivered at 20 or more gestational weeks in a 2-year time period at four hospitals across the United States: University of California San Francisco, Northwestern Memorial Hospital, MetroHealth Medical Center in Cleveland, and University of Alabama at Birmingham. All patients included had permanent contraception documented as their postpartum contraceptive plan. We used modified Poisson models to estimate the associations among race and ethnicity, insurance type, and fulfillment of permanent contraception before hospital discharge, within 6 weeks of delivery, and within 1 year of delivery, adjusting for age, parity, gestational age, delivery type, marital status, body mass index, insurance type, adequacy of prenatal care, and hospital site.

RESULTS:

Of 2,945 people in our cohort, 1,243 (42.2%) were non-Hispanic Black, and 820 (27.8%) were Hispanic, and 882 (30.0%) were non-Hispanic White. Overall, 1,731 of 2,945 patients (58.2%) who desired postpartum permanent contraception received it before hospital discharge, 1,746 of 2,945 (59.3%) received it within 6 weeks of delivery, and 1,927 of 2,945 (65.4%) received it within 1 year of delivery. Across all racial and ethnic groups, patients with Medicaid insurance were less likely to have their desired postpartum permanent contraception procedure fulfilled compared with patients with private insurance. In unadjusted models, non-Hispanic Black patients were less likely to have their desired postpartum permanent contraception procedure fulfilled. In an examination of interaction with insurance type, non-Hispanic Black patients with private insurance were less likely to have permanent contraception fulfilled compared with non-Hispanic White patients with private insurance before adjustment. After adjustment, there were no significant associations between race and postpartum permanent contraception fulfillment among those with Medicaid or private insurance.

CONCLUSION:

In unadjusted models, we find marked racial disparities in fulfillment of permanent contraception. Controlling for individual- and facility-level factors eliminated associations among race, ethnicity, insurance type, and fulfillment, likely because covariates are mediators on the pathway between racism and fulfillment.
Transcending Language Barriers in Obstetrics and Gynecology
Authors: Truong Samantha , Foley Olivia W. , Fallah Parisa , Lalla Amber Trujillo , Osterbur Badhey Marika , Boatin Adeline A. , Mitchell Caroline M. , Bryant Allison S. , Molina Rose L.
Published: September 2023

There is growing evidence that language discordance between patients and their health care teams negatively affects quality of care, experience of care, and health outcomes, yet there is limited guidance on best practices for advancing equitable care for patients who have language barriers within obstetrics and gynecology. In this commentary, we present two cases of language-discordant care and a framework for addressing language as a critical lens for health inequities in obstetrics and gynecology, which includes a variety of clinical settings such as labor and delivery, perioperative care, outpatient clinics, and inpatient services, as well as sensitivity around reproductive health topics. The proposed framework explores drivers of language-related inequities at the clinician, health system, and societal level. We end with actionable recommendations for enhancing equitable care for patients experiencing language barriers. Because language and communication barriers undergird other structural drivers of inequities in reproductive health outcomes, we urge obstetrician–gynecologists to prioritize improving care for patients experiencing language barriers.
Bridging Health Disparities and Improving Reproductive Outcomes With Health Center–Affiliated Doula Programs
Authors: Marudo Catherine , Nicotra Caroline , Fletcher Michelle , Lanning Rhonda , Nelson Melissa , Hancock Ciara
Published: September 2023

Doulas are community perinatal professionals trained in pregnancy health, childbirth preparation, labor support, lactation counseling, and postnatal care. Doulas serve as patient advocates and provide laboring patients with continuous one-to-one support including informational, physical, and emotional support. Research shows that access to continuous labor support contributes to positive health outcomes such as increasing rates of spontaneous vaginal delivery, shorter labor, less need for analgesics, and increased satisfaction with the birthing process. However, despite their benefits, socioeconomic, structural, and systemic factors limit doula accessibility and manifest in low utilization among patients who could benefit from doulas the most. Given the positive health implications of doula support and the need for these services in underserved populations, there is an urgency to increase the accessibility of doulas. Several health centers in the United States have created successful doula programs to meet the needs of their patient populations. To better understand these programs, we interviewed and collaborated on this paper with program representatives from Boston Medical Center's Birth Sisters and DREAM: Delivery Resources, Education, and Advocacy for Moms; UNC Health’s Birth Partners; and Michigan Medicine's Dial-A-Doula. Because many health centers serve as large public safety-net hospitals, having more health center–affiliated doula programs nationwide could be a positive step in bridging disparities and improving maternal and child health.
Data Equity for Asian American and Native Hawaiian and Other Pacific Islander People in Reproductive Health Research
Authors: Heyrana Katrina J. , Kaneshiro Bliss , Soon Reni , Nguyen Brian T. , Natavio Melissa F.
Published: September 2023

Though racial and ethnic disparities in sexual and reproductive health outcomes are receiving greater interest and research funding, the experiences of Asian American and Native Hawaiian and Other Pacific Islander (NHPI) people are often combined with those of other racial and ethnic minority groups or excluded from data collection altogether. Such treatment is often rationalized because Asian American and NHPI groups comprise a smaller demographic proportion than other racial or ethnic groups, and the model minority stereotype assumes that these groups have minimal sexual and reproductive health needs. However, Asian American and NHPI people represent the fastest-growing racial-ethnic groups in the United States, and they face disparities in sexual and reproductive health access, quality of care, and outcomes compared with those of other races and ethnicities. Disaggregating further by ethnicity, people from certain Asian American and NHPI subgroups face disproportionately poor reproductive health outcomes that suggest the need for culturally targeted exploration of the unique drivers of these inequities. This commentary highlights the evidence for sexual and reproductive health disparities both in and between Asian American and NHPI groups. We also examine the failures of national data sets and clinical studies to recruit Asian American and NHPI people in proportion to their share of the U.S. population or to consider how the cultural and experiential diversity of Asian American and NHPI people influence sexual and reproductive health. Lastly, we provide recommendations for the equitable inclusion of Asian American and NHPI people to promote and systematize the study and reporting of sexual and reproductive health behaviors and outcomes in these culturally, religiously, and historically diverse groups.
An Intervention-Based Approach to Achieve Racial Equity in Gynecologic Oncology
Authors: Gamble Charlotte , Woodard Tyler J. , Yakubu Ayesha I. , Chapman-Davis Eloise
Published: September 2023

Racial inequities within gynecologic oncology exist at every step of the cancer continuum. Although the disparities have been well described, there is a significant gap in the literature focused on eliminating inequities in gynecologic cancer outcomes. The goal of this narrative review is to highlight successful, evidence-based interventions from within and outside of gynecologic oncology that alleviate disparity, providing a call to action for further research and implementation efforts within the field. These solutions are organized in the socioecologic framework, where multiple levels of influence—societal, community, organizational, interpersonal, and individual—affect health outcomes.
Opportunistic CT-Based Hounsfield Units Strongly Correlate with Biomechanical CT Measurements in the Thoracolumbar Spine
Authors: Martini Michael L. , Mikula Anthony L. , Lakomkin Nikita , Pennington Zach , Everson Megan C. , Hamouda Abdelrahman M. , Bydon Mohamad , Freedman Brett , Sebastian Arjun S. , Nassr Ahmad , Anderson Paul A. , Baffour Francis , Kennel Kurt A. , Fogelson Jeremy , Elder Benjamin
Published: September 2023

Study Design.

Retrospective cohort study.

Objective.

Hounsfield units (HUs) are known to correlate with clinical outcomes, but no study has evaluated how they correlate with biomechanical computed tomography (BCT) and dual-energy x-ray absorptiometry (DXA) measurements.

Summary of Background.

Low bone mineral density (BMD) represents a major risk factor for fracture and poor outcomes following spine surgery. DXA can provide regional BMD measurements but has limitations. Opportunistic HUs provide targeted BMD estimates; however, they are not formally accepted for diagnosing osteoporosis in current guidelines. More recently, BCT analysis has emerged as a new modality endorsed by the International Society for Clinical Densitometry for assessing bone strength.

Methods.

Consecutive cases from 2017 to 2022 at a single institution were reviewed for patients who underwent BCT in the thoracolumbar spine. BCT-measured vertebral strength, trabecular BMD, and the corresponding American College of Radiology Classification were recorded. DXA studies within three months of the BCT were reviewed. Pearson Correlation Coefficients were calculated, and receiver-operating characteristic curves were constructed to assess the predictive capacity of HUs. Threshold analysis was performed to identify optimal HU values for identifying osteoporosis and low BMD.

Results.

Correlation analysis of 114 cases revealed a strong relationship between HUs and BCT vertebral strength (r=0.69; P<0.0001; R
2=0.47) and trabecular BMD (r=0.76; P<0.0001; R
2=0.58). However, DXA poorly correlated with opportunistic HUs and BCT measurements. HUs accurately predicted osteoporosis and low BMD (Osteoporosis: C=0.95, 95% CI 0.89–1.00; Low BMD: C=0.87, 95% CI 0.79–0.96). Threshold analysis revealed that 106 and 122 HUs represent optimal thresholds for detecting osteoporosis and low BMD.

Conclusion.

Opportunistic HUs strongly correlated with BCT-based measures, while neither correlated strongly with DXA-based BMD measures in the thoracolumbar spine. HUs are easy to perform at no additional cost and provide accurate BMD estimates at noninstrumented vertebral levels across all American College of Radiology-designated BMD categories.
Preoperative Optimization for Adult Spinal Deformity Surgery
Authors: Katiyar Prerana , Reyes Justin , Coury Josephine , Lombardi Joseph , Sardar Zeeshan
Published: September 2023

Study Design.

Systematic Review

Objective.

The purpose of this review is to identify modifiable risk factors in patients undergoing adult spinal deformity surgery and compile literature recommendations for preoperative optimization of these risk factors.

Summary of Background Data.

Optimization of modifiable risk factors not only benefits the patient but also lessens resource and cost burdens on the healthcare system, allowing for better quality and value-based care. There is limited but applicable literature discussing preoperative optimization in adult spinal deformity surgery patients specifically.

Methods.

We searched PubMed for studies that looked at one of the variables of interest (e.g. osteoporosis, prehabilitation and functional status, multidisciplinary preoperative screening, infection, obesity, nutrition, smoking, diabetes, blood loss, chronic opioid use and psychosocial factors) in adult patients with spinal deformity according to PRISMA guidelines.

Results.

70 studies were included in the final review and synthesis of information. Guidelines and recommendations from these studies were compared and compiled into evidence based action items for preoperative optimization of modifiable risk factors prior to adult spinal deformity surgery.

Conclusions.

While the approach of preoperative optimization of modifiable risk factors may incur additional planning efforts and patient care time, it has the potential to significantly reduce perioperative complications and reduce morbidity and mortality during surgery, thus allowing for improved outcomes, increased quality of life, and satisfaction from this patient population.

Level of Evidence.

III
Single-Center Experience With Lung Transplant Evaluation Referrals of Acute Respiratory Distress Syndrome Patients During the COVID-19 Pandemic: How Do You Make Up For Lost Time?
Authors: Cerier Emily J. , Toyoda Takahide , McNulty Colleen , O’Boye Anne , Kurihara Chitaru , Bharat Ankit , Nadig Nandita R.
Published: September 2023

Transfer of select, medically refractory acute respiratory distress syndrome patients to lung transplant centers requires extensive resources. Here, we report 270 consecutive lung transplant patient referrals to our center for medically refractory ARDS from June 2021 to April 2022, following the implementation of clinical care pathways for intake of these patients. Eighty-seven of 270 patients (32.2%) met screening criteria and were evaluated for transfer within a median of 12 days, during which 38 of 87 patients (43.7%) died and 12 of 87 patients (13.8%) transferred elsewhere. Thirty-seven of 87 patients (42.5%) were accepted for transfer of which 16 of 37 patients (43.2%) successfully transferred to our center with a median transfer waiting period of 12 days. Because of resource constraints, 21 of 37 accepted patients (56.8%) could not be transferred of which 9 of 21 patients (42.9%) died while waiting. Nine of 16 transferred patients (56.2%) eventually underwent lung transplantation with over 80% 6-month survival. ARDS patients referred for transplantation have high risk of mortality and, therefore, require well-described pathways for evaluation and transfer.
Anticipating HIV viral escape – resistance to active and passive immunization
Authors: Williamson Carolyn , Lynch Rebecca M. , Moore Penny L.
Published: September 2023

Purpose

Active and passive immunization strategies are challenged by the extraordinary diversity of HIV, and the need for high titers of neutralizing antibodies to confer protective immunity. This review summarises recent studies and the barrier that these interventions will need to overcome to prevent viral resistance.

Recent findings

Studies from the antibody mediated prevention trial identified a measure of protective titers, finding that higher titers than anticipated will be needed to prevent infection. This benchmark has advanced our ability to predict combinations of broadly neutralizing antibodies (bNAbs) that will provide optimal coverage. To limit escape, these combinations should ensure that the majority of viruses are bound by a minimum of two antibodies. The characterization of currently circulating viruses has revealed increased resistance to some bNAbs over time, highlighting the need for continued surveillance, especially in under-studied populations and subtypes. Active vaccination will face similar challenges in combating diversity, although despite successes in germline targeting, this approach is not yet able to elicit bNAbs.

Cumulatively these studies highlight the need to target multiple antibody epitopes for maximum coverage, but also to restrict escape pathways. Successful immunization strategies should anticipate viral escape and devise strategies to counteract this.
Controversies in axillary management of patients with breast cancer – updates for 2024
Authors: Tauber Nikolas , Bjelic-Radisic Vesna , Thill Marc , Banys-Paluchowski Maggie
Published: September 2023

Purpose of review

For some time now, the question of de-escalation in axillary staging in breast cancer patients has been raised. The aim is to improve the patients’ quality of life and reduce morbidity by optimizing surgical strategies with a high level of oncological safety. This review offers a current overview of published evidence and clinical practice, aiming to guide the surgical community as they reassess and reshape their practices.

Recent findings

Years after introducing sentinel lymph node biopsy (SLNB) in clinically node negative breast cancer patients several guidelines suggest completely omitting SLNB in older patients with low-risk tumors. It is worth noting that for patients with a metastatic sentinel lymph node in the upfront surgery setting, a de-escalation of axillary surgery may in fact lead to an escalation of radiation therapy. Currently, there is limited evidence on the axillary surgical approach for patients with initially positive node status achieving complete axillary response (ycN0), resulting in heterogenous guideline recommendations.

Innovative trials are contributing to a growing evidence on de-escalation of axillary surgery with the aim of reducing arm morbidity and improving long-term health-related quality of life.
Intravascular Papillary Endothelial Hyperplasia (Masson Tumor) of the Right Thumb: A Case Report and Literature Review
Authors: Alkabbaa Saud , Alassaf Hala M. , Alothman Mohammed A. , Alammar Alwaleed , Alkhotani Mona , Alsolami Afaf
Published: September 2023

The Masson tumor is a benign vascular tumor named after Pierre Masson, the French pathologist who originally described it in 1923, terming it “hémangio-endothéliome végétant intravasculaire.” It is a rare tumor that can arise in any area throughout the body. However, the exact cause of Masson tumor remains poorly understood, and its diagnosis is challenging and difficult to distinguish from several other soft-tissue tumors. In this report, we report a case of Masson tumor arising in the right thumb that is only the second reported case in the hand in Saudi Arabia.
Can You Go the Distance: Collagenase Clostridium histolyticum Manipulation at 1 Month after Injection
Authors: Pflibsen Lacey R. , Jain Nirbhay S. , Benhaim Prosper
Published: September 2023

Collagenase Clostridium histolyticum is a popular treatment in Dupuytren contracture. Current guidelines are for manipulation 24 hours to 7 days after injection. We present a case of successful manipulation 28 days after injection.
Geometric Wire-frame Fixation of Skin Grafting for Lip Reconstruction
Authors: Ishii Nobuaki , Akimoto Masataka , Ogawa Rei
Published: September 2023

Postoperative fixation is required for skin grafts on mobile sites. External wire-frame fixation technique has demonstrated a beneficial role for grafts in specific areas such as lips, eyelids, and fingers. Although this technique is sufficient in most cases, patients with psychosis fail to maintain the lip in resting position, which led us to consider using a more rigid fixation method, known as “Geometric wire-frame fixation.” Surgical technique included fixing a perimeter frame around skin graft similar to the conventional external wire-frame fixation. In addition, a geometric frame was prepared to divide the area of the graft geometrically. Then, it was placed on gauze to compress the grafted skin, and connected to the perimeter frame. In case 1, a 33-year-old man with a history of schizophrenia and presenting with flame burn injury sustained while attempting suicide was admitted. The scar on the lips was excised, and an external wire-frame fixation was performed. However, postoperative vigorous mouth movements caused incomplete survival of the skin graft. Geometric wire-frame fixation was performed in the next operation, and the graft fully survived. The patient in case 2 was a 62-year-old man who developed a facial scar contracture after chemical injury by sulfuric acid. We performed geometric wire-frame fixation with contracture release of the upper lip, and the skin graft was fully taken. The geometric wire-frame fixation method allows for rigid fixation of the skin graft and can be considered as a valuable option, especially for lip reconstruction in poorly compliant patients who are unable to maintain proper resting lips.
Neurologic impact of atrial fibrillation
Authors: Feldman Daniel R. , Zeitler Emily P.
Published: September 2023

Purpose of review

Cognitive dysfunction is a complex condition that is becoming increasingly more prevalent. There has been growing acknowledgement that individuals with atrial fibrillation are at an increased risk of cognitive dysfunction beyond the association of age with both disorders. The purpose of this review is to explore the potential underlying mechanisms connecting atrial fibrillation and cognitive dysfunction and to examine the existing evidence for potential treatment options.

Recent findings

Many mechanisms have been proposed for the association between cognitive dysfunction and atrial fibrillation. These include cerebral infarction (both micro and macro embolic events), cerebral microbleeds including those secondary to therapeutic anticoagulation, an increased inflammatory state, cerebral hypoperfusion, and a genetic predisposition to both diseases. Treatments designed to target each of these mechanisms have led to mixed results and there are no specific interventions that have definitively led to a reduction in the incidence of cognitive dysfunction.

The relationship between cognitive dysfunction and atrial fibrillation remains poorly understood. Standard of care currently focuses on reducing risk factors, managing stroke risk, and maintaining sinus rhythm in appropriately selected patients. Further work needs to be conducted in this area to limit the progression of cognitive dysfunction in patients with atrial fibrillation.
Randomized, double-blind, controlled trial of a combination of alpha-lipoic acid and pregabalin for neuropathic pain: the PAIN-CARE trial
Authors: Gilron Ian , Robb Sylvia , Tu Dongsheng , Holden Ronald R. , Jackson Alan C. , Duggan Scott , Milev Roumen
Published: September 2023

We compared a combination of the nonsedating antioxidant, alpha-lipoic acid (ALA), with the sedating anticonvulsant, pregabalin, vs each monotherapy to treat neuropathic pain due to peripheral neuropathies. In this randomized, double-blind, 3-period crossover trial, participants received oral ALA, pregabalin, and their combination—each for 6 weeks. The primary outcome was mean daily pain intensity at maximal tolerated doses (MTD); secondary outcomes included quality of life (SF-36), sleep (Medical Outcomes Study-Sleep Scale), adverse effects, drug doses, and other measures. Of 55 participants randomized (20—diabetic neuropathy, 19—small fiber neuropathy, and 16—other neuropathies), 46 completed 2 periods, and 44 completed 3. At MTD, the primary outcome of mean pain intensity (0-10) was 5.32 (standard error, SE = 0.18), 3.96 (0.25), 3.25 (0.25), and 3.16 (0.25) at baseline, ALA, pregabalin, and combination, respectively (P < 0.01 for ALA vs combination and pregabalin). Treatment differences were similar in subgroups with diabetic neuropathy and with other neuropathies. SF-36 total scores (higher number indicates better quality of life) were 66.6 (1.88), 70.1 (1.88), and 69.4 (1.87) with ALA, pregabalin, and combination (P < 0.05 for ALA vs combination and pregabalin). At MTD, there were no statistically significant treatment differences in adverse effects or drug doses. This trial demonstrates superiority of pregabalin vs ALA but provides no evidence to suggest added benefit of combining ALA with pregabalin to treat neuropathic pain.
HPV+ head and neck cancer–derived small extracellular vesicles communicate with TRPV1+ neurons to mediate cancer pain
Authors: Inyang Kufreobong E. , Evans Christine M. , Heussner Matthew , Petroff Margaret , Reimers Mark , Vermeer Paola D. , Tykocki Nathan , Folger Joseph K. , Laumet Geoffroy
Published: September 2023

Severe pain is often experienced by patients with head and neck cancer and is associated with a poor prognosis. Despite its frequency and severity, current treatments fail to adequately control cancer-associated pain because of our lack of mechanistic understanding. Although recent works have shed some light of the biology underlying pain in HPV-negative oral cancers, the mechanisms mediating pain in HPV+ cancers remain unknown. Cancer-derived small extracellular vesicles (cancer-sEVs) are well positioned to function as mediators of communication between cancer cells and neurons. Inhibition of cancer-sEV release attenuated pain in tumor-bearing mice. Injection of purified cancer-sEVs is sufficient to induce pain hypersensitivity in naive mice that is prevented by QX-314 treatment and in Trpv1

−/−
mice. Cancer-sEVs triggered calcium influx in nociceptors, and inhibition or ablation of nociceptors protects against cancer pain. Interrogation of published sequencing data of human sensory neurons exposed to human cancer-sEVs suggested a stimulation of protein translation in neurons. Induction of translation by cancer-sEVs was validated in our mouse model, and its inhibition alleviated cancer pain in mice. In summary, our work reveals that HPV+ head and neck squamous cell carcinoma–derived sEVs alter TRPV1+ neurons by promoting nascent translation to mediate cancer pain and identified several promising therapeutic targets to interfere with this pathway.
Physician Assistant Student Attitudes Toward Gamification of Cardiac Auscultation Instruction
Authors: Garvick Sarah , Gillette Chris , Bates Nathan , Jackson Toni , Gao Hong , Crandall Sonia
Published: September 2023

Introduction

Current physician assistant (PA) learners have a clear preference for interactive learning that is vibrantly present in new media technologies. At present, there is a paucity of research regarding use or acceptability of gamification in PA education. The purpose of this study was to examine PA students' experience with, attitudes toward, and outcomes of a gamified cardiac auscultation curriculum.

Methods

Faculty at one institution designed an interactive Mobile App Cardiac Auscultation Curriculum (MACAC). The MACAC incorporates independent and group learning using the Littmann Learning mobile app. Author-created surveys as well as knowledge and auscultation assessment tools were delivered to all students.

Results

Most of the students recommended the use of the app for future cohorts and reported confidence to accurately identify normal and abnormal heart sounds. Knowledge and auscultation assessment scores demonstrated proficiency in identification of normal and abnormal heart sounds.

Discussion

Gamification research is important because blended learning that incorporates new media technologies with traditional approaches can help overcome the limitations of passive learning environments. This study provides evidence that the use of a mobile app can be an effective and innovative method to teach cardiac auscultation to the 21st century PA learners.
Breast cancer pre-clinical screening using infrared thermography and artificial intelligence: a prospective, multicentre, diagnostic accuracy cohort study
Authors: Wang Xuefei , Chou Kuanyu , Zhang Guochao , Zuo Zhichao , Zhang Ting , Zhou Yidong , Mao Feng , Lin Yan , Shen Songjie , Zhang Xiaohui , Wang Xuejing , Zhong Ying , Qin Xue , Guo Hailin , Wang Xiaojie , Xiao Yao , Yi Qianchuan , Yan Cunli , Liu Jian , Li Dongdong , Liu Wei , Liu Mengwen , Ma Xiaoying , Tao Jiangtao , Sun Qiang , Zhai Jidong , Huang Likun
Published: September 2023

Background:

Given the limited access to breast cancer (BC) screening, the authors developed and validated a mobile phone-artificial intelligence-based infrared thermography (AI-IRT) system for BC screening.

Materials and methods:

This large prospective clinical trial assessed the diagnostic performance of the AI-IRT system. The authors constructed two datasets and two models, performed internal and external validation, and compared the diagnostic accuracy of the AI models and clinicians. Dataset A included 2100 patients recruited from 19 medical centres in nine regions of China. Dataset B was used for independent external validation and included 102 patients recruited from Langfang People’s Hospital.

Results:

The area under the receiver operating characteristic curve of the binary model for identifying low-risk and intermediate/high-risk patients was 0.9487 (95% CI: 0.9231–0.9744) internally and 0.9120 (95% CI: 0.8460–0.9790) externally. The accuracy of the binary model was higher than that of human readers (0.8627 vs. 0.8088, respectively). In addition, the binary model was better than the multinomial model and used different diagnostic thresholds based on BC risk to achieve specific goals.

Conclusions:

The accuracy of AI-IRT was high across populations with different demographic characteristics and less reliant on manual interpretations, demonstrating that this model can improve pre-clinical screening and increase screening rates.
Cost-effectiveness and prognostic model of hepatic arterial infusion chemotherapy for hepatocellular carcinoma with high tumor burden and/or Vp4 tumor thrombus compared with sorafenib: a post-hoc analysis of the FOHAIC-1 trial
Authors: Chen Qi-Feng , Lyu Ning , Wang Xun , Jiang Xiong-Ying , Hu Yue , Chen Song , Zhong Sui-Xing , Huang Zi-Lin , Chen Minshan , Zhao Ming
Published: September 2023

Objectives:

The phase III FOHAIC-1 trial revealed that hepatic arterial infusion of chemotherapy (HAIC) improved overall survival compared to sorafenib in the high-risk hepatocellular carcinoma (HCC). This study therefore set out to evaluate the cost-effectiveness and establish a prognostic clinico-radiological score of HAIC.

Materials and methods:

A total of 409 patients with high-risk HCC who received HAIC between 2014 and 2020 were included. A Markov model was applied in the cost-effectiveness analysis using data from the FOHAIC-1 trial. In prognosis analysis, a clinico-radiological score was developed using a Cox-regression model and subsequently confirmed in the internal validation and test cohorts. The area under the curve from receiver operator characteristic analysis was used to assess the performance of the clinico-radiological score.

Results:

HAIC resulted in an incremental cost-effectiveness ratio of $10190.41/quality-adjusted life years compared to sorafenib, which was lower than the willingness-to-pay threshold. Probabilistic sensitivity analysis predicted a ≥99.9% probability that the incremental cost-effectiveness ratio was below the willingness-to-pay. The Cox analysis identified five factors, namely extrahepatic metastasis (m), arterial enhancing type (a), tumor number (nu), albumin-bilirubin index (a), and involved lobe (l), which together comprise the clinico-radiological score (HAIC-manual). Patients were classified into three groups based on the number of factors present, with cutoffs at 2 and 4 factors. The stratified median overall survival for these groups were 21.6, 10.0, and 5.9 months, respectively (P<0.001). These findings were verified through internal validation and test cohorts with a significance level of P≤0.01. The time-dependent area under the curve from receiver operator characteristic for the ability of the HAIC-manual to predict survival in 1, 2, and 3 years were 0.71, 0.76, and 0.78, which significantly outperformed existing staging systems.

Conclusion:

HAIC is a promising and cost-effective strategy for patients with high-risk HCC. The clinico-radiological score may be a simple prognostic tool for predicting HAIC treatment.
Do Sport-Related Concussions Later in the Season Take Longer to Recover From?
Authors: Jo Jacob , Hill Tyler M. , Williams Kristen L. , Prosak Olivia L. , Amedy Amad , Anesi Trevor J. , Terry Douglas P. , Zuckerman Scott L.
Published: September 2023

Objective:

In a cohort of high-school football athletes with sport-related concussion (SRC), we sought to investigate the role of seasonality, defined as time of injury during a season, on recovery.

Design:

Retrospective cohort study.

Setting:

Regional sport concussion center.

Participants:

High-school football athletes ages 14 to 19 –years old who sustained an SRC from 11, 2017 to 04, 2022.

Intervention:

Athletes were divided into 3 groups based on seasonality: early, middle, and late season.

Main Outcome Measures:

The primary outcomes were initial Post-Concussion Symptom Scale score and recovery, as defined by time to return-to-learn (RTL), symptom resolution, and return-to-play (RTP). Descriptive statistics, analysis-of-variance, t tests, and multivariable regressions were performed.

Results:

Of our cohort of 273 high-school football players who sustained an SRC, 97 (35.5%) sustained an SRC during early season, 107 (39.2%) during middle season, and 69 (25.3%) during late season. Compared with late-season concussions, early-season concussions took less days to symptom resolution (early = 11.5 ± 12.9 vs late = 25.5 ± 27.0, P = 0.03), but no differences were found in days to RTL (early = 5.3 ± 4.8 vs late = 7.2 ± 15.8, P = 0.51) and RTP (early = 13.5 ± 11.8 vs late = 23.0 ± 22.8, P = 0.08). Seasonality was not a significant predictor for any recovery metric in multivariable regressions.

Conclusion:

Sport-related concussions occurring in the early third of the season took significantly less time to symptom resolution than those occurring in the later third of the season; however, this was not statistically significant in multivariable analyses. No association was observed between seasonality and time to RTL and RTP. A trend of worse recovery with concussions later in the season may be present.
Clinically Significant Prostate Cancer in Men With High-Grade Intraepithelial Prostatic Intraepithelial Neoplasia or Atypical Small Acinar Proliferation
Authors: Norman Robert D. , Garg Harshit , Rickborn Lanette , Kaushik Dharam , Pruthi Deepak Kumar , Mansour Ahmed M. , Thompson Ian M. , Liss Michael A.
Published: September 2023

Purpose:

The clinical management of Atypical Small Acinar Proliferation (ASAP) and High-Grade Prostate Intraepithelial Neoplasia (HGPIN) varies significantly. The aim of this study was to characterize the incidence and natural history of ASAP and HGPIN lesions to optimize follow-up strategies.

Materials and Methods:

A retrospective analysis of patients at a VA Medical Center who underwent a prostate needle biopsy between 1988 and 2017 was performed. The pathological lesions were grouped as ASAP, HGPIN, and ASAP & HGPIN. The primary outcome was the incidence of clinically significant prostate cancer (csPCa) defined as grade group ≥2 prostate cancer.

Results:

Of 6104 patients screened, 312 patients included having ASAP (n = 70, 1.1%), HGPIN (n = 222, 3.6%), or ASAP & HGPIN (n = 20, 0.3%). Follow-up biopsy was performed in 99.3% of patients. The incidence of prostate cancer in ASAP, HGPIN, or ASAP & HGPIN groups was 46.3%, 37%, and 68.4%, respectively (P = .03). However, the rate of csPCa was similar across the 3 groups (10.1% in ASAP, 10.3% in HGPIN, and 10.5% in ASAP & HGPIN, P = .6). The median time to cancer diagnosis was significantly shorter for patients with ASAP (2.8 years for ASAP, 4.9 years for HGPIN, and 1.5 years for ASAP & HGPIN, P = .001); however, there was no significant difference in time to diagnosis of csPCa between the various groups (P = .7).

Conclusion:

Both ASAP and HGPIN have a low risk of progression to csPCa. This, coupled with a prolonged time to any cancer diagnosis, suggests that immediate repeat biopsy might not be necessary among these patients.
Identification and detection of microRNA kidney disease biomarkers in liquid biopsies
Authors: Smith Daniel A. , Redman James E. , Fraser Donald J. , Bowen Timothy
Published: September 2023

Purpose of review

MicroRNAs (miRNAs) are emerging rapidly as a novel class of biomarkers of major organ disorders, including kidney diseases. However, current PCR-based detection methods are not amenable to development for high-throughput, cost-effective miRNA biomarker quantification.

Recent findings

MiRNA biomarkers show significant promise for diagnosis and prognosis of kidney diseases, including diabetic kidney disease, acute kidney injury, IgA nephropathy and delayed graft function following kidney transplantation. A variety of novel methods to detect miRNAs in liquid biopsies including urine, plasma and serum are being developed. As miRNAs are functional transcripts that regulate the expression of many protein coding genes, differences in miRNA profiles in disease also offer clues to underlying disease mechanisms.

Recent findings highlight the potential of miRNAs as biomarkers to detect and predict progression of kidney diseases. Developing in parallel, novel methods for miRNA detection will facilitate the integration of these biomarkers into rapid routine clinical testing and existing care pathways. Validated kidney disease biomarkers also hold promise to identify novel therapeutic tools and targets.

Video abstract

http://links.lww.com/CONH/A43
Update on the evaluation and management of dysphagia in sporadic inclusion body myositis
Authors: Garand Kendrea L. (Focht) , Malandraki Georgia A. , Dimachkie Mazen M.
Published: September 2023

Purpose of review

Dysphagia is a common symptom of sporadic inclusion body myositis (IBM), affecting disease trajectory and patient quality-of-life. Despite this, it is considerably understudied. The purpose of this review is to summarize current evidence related to the evaluation and management of dysphagia in IBM. We highlight a patient case involving a multidisciplinary management approach, and we encourage continued exploration of exercises for delaying progression and improving impairments in patients with IBM and dysphagia.

Recent findings

Recent investigations confirm that dysphagia in IBM is a debilitating and complex symptom that warrants timely evaluation and management. Further, they highlight the lack of validation of standardized swallowing-related metrics specifically for IBM and the limited evidence supporting a consensus of management approaches. Small scale research and clinical anecdotal data support a multidisciplinary and multipronged patient-centered approach, including rehabilitative exercise protocols, for dysphagia management in IBM.

A paucity exists in the literature to effectively guide clinical decision-making for patients with IBM and dysphagia. Given this, it is our belief that a careful multidisciplinary and multipronged patient-centered approach is critical for dysphagia management in IBM. Prospective, longitudinal research on the underlying mechanisms of swallowing dysfunction using advanced and validated swallowing-related outcome measures is urgently needed.
Development of a Metaverse Online Learning System for Undergraduate Nursing Students
Authors: Ryu Hyeongju , Lee Hyeongsuk , Yoo Hye Jin
Published: September 2023

Background:

An active online learning environment enables 2-way communication wherein students can engage in problem-based learning and projects, unlike fragmented lecture-style classes.

Purpose:

This pilot study aimed to develop a metaverse-based online learning system and evaluate its usability.

Methods:

A rapid prototyping model and Gather.town was used to design and develop a metaverse classroom. Participants were 10 nursing students from a college in South Korea. To evaluate usability, 10 tasks were configured and 2 pilot tests were conducted. The degree of difficulty, time required to perform tasks, and students' experience were investigated.

Results:

The Metaverse for Education of Nursing Students was successfully completed, incorporating student feedback and addressing identified areas for improvement.

Conclusion:

This study reflects a learner-centered educational environment through the direct participation in the development process of the instructors who conducted the lectures. The metaverse space can be widely applied in creative nursing education in the future.
Case Report: Spontaneous Closure of Idiopathic Full-thickness Macular Hole and Early Development of Lamellar Hole
Authors: Tozzi Luigi , Gius Irene , Greggio Angelo , Meduri Alessandro , De Salvo Gabriella , Parolini Barbara , Frisina Rino
Published: September 2023

SIGNIFICANCE

Spontaneous closure of an idiopathic full-thickness macular hole (FTMH) is a rare event. The underlying mechanisms are unclear because of the difficulty in detecting subtle structural changes even with serial imaging. Previous reports are largely optical coherence tomography (OCT) based, but multimodal imaging could highlight new information.

PURPOSE

This study aimed to report the spontaneous closure of an idiopathic FTMH (iFTMH) and its recurrence and late closure documented by serial OCT integrated with multimodal imaging modalities and microperimetry (MP).

CASE REPORT

A healthy 46-year-old man was referred to the Department of Ophthalmology of the University of Padova for an iFTMH in the right eye with preserved visual acuity. The patient was scheduled for monthly controls up to 12 months by an integrated assessment of OCT, angiography-OCT, short-wavelength fundus autofluorescence, and MP. Two months later, tracked OCT scans showed a closure of the hole with a residual lamellar macular hole. Sequential examinations revealed a discontinuation of photoreceptors (ellipsoid zone) and a recurrence of iFTMH, and 7 months later, iFTMH reclosed without any relevant changes up to 12 months. Foveal avascular zone area increased from the baseline reaching its maximum value when iFTMH recurred. Two hyper–fundus autofluorescence points were detected in the foveal area, one progressively decreased and one reached the most intense signal when iFTMH recurred. Retinal sensitivity decreased mostly in one hyper–fundus autofluorescence point when the ellipsoid zone line discontinued and reached the lowest value when iFTMH recurred, and increased mostly in the other points when iFTMH reclosed.

CONCLUSIONS

Spontaneous iFTMH closure, as well as its recurrence and reclosure, is a rare event. By monitoring with multiple imaging modalities, MP and their overlaying elaboration can add new biomarkers with diagnostic and prognostic value.
Older Adults’ Social Profiles and Links to Functional and Biological Aging in the United States and Mexico
Authors: Wilson Stephanie J. , Marini Christina M.
Published: September 2023

Objective

Social stress—loneliness, isolation, and low relationship quality—increase risks of aging-related diseases. However, the ways in which they intersect to undermine healthy aging remain poorly understood. We used latent class analysis to identify groups of older adults based on their social stress in both the United States and Mexico. Thereafter, we examined their cross-sectional associations with markers of functional and biological aging.

Method

Participants in the Health and Retirement Study (HRS; N = 8316) and Mexican Health and Aging Study (MHAS; N = 15,001) reported their loneliness, isolation (i.e., living alone), and relationship quality with spouse, children, and friends. Outcomes included C-reactive protein, functional limitations, self-rated health, comorbidities, gait speed, and grip strength. Models controlled for demographics, health behaviors, and body mass index.

Results

In both countries, five classes emerged, a supported group and four with elevated social stress: a) strained, b) isolated, c) spousal ambivalence, and d) unhappily married. Compared with the others, strained participants in both samples had greater functional limitations, poorer self-rated health, and more comorbidities, as well as slower gait in HRS and weaker grip in MHAS. Generally, supported participants fared better than the other groups. In HRS, C-reactive protein levels differed between the strained group and others, but these associations were explained by health behaviors and body mass index.

Conclusions

Older adults in both countries with strained relationships fared worst in their aging-related outcomes, revealing new insights about the links between toxic social stress and unhealthy aging.