bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of safety and care services on psychological outcomes and housing satisfaction in Korean middle-aged and older adults living alone
Authors: Lim Jung-Won , Park Hwa-Ok Hannah , Kim Min Jung
Published: July 2023

Background

Korean society has witnessed a rapid increase in the number of single-person households at risk for loneliness or solitary deaths. This study aims to evaluate the effectiveness of safety and care services (SCS) on the psychological outcomes and housing satisfaction of Korean middle-aged and older adults living alone.

Methods

This study was a randomized controlled trial on residents of public rental housing. A total of 40 people underwent a 3-month intervention. For the experimental group, a caring service IoT solution was installed in participants’ houses, and coordinators provided services using IoT information. The control group received only visits by coordinators.

Results

The experimental group showed significant positive changes in depressive symptoms. An interaction effect of time and condition was observed, indicating that the loneliness scores of the experimental group were significantly reduced, whereas those of their counterparts were negligible. Both groups showed significant decreases in suicidal thoughts. Housing satisfaction in both groups significantly increased over time, but group differences were observed.

Conclusions

This study demonstrated the positive effects of SCS on depressive symptoms, suicidal thoughts and housing satisfaction for people living alone, suggesting that technology can be a useful tool for helping vulnerable people.
What Private Equity Does Differently: Evidence from Life Insurance
Authors: Kirti Divya , Sarin Natasha
Published: July 2023

This paper studies how private equity creates value and its consequences for consumer welfare in the insurance industry, where PE investments grew tenfold following the financial crisis. PE firms add value through regulatory and tax arbitrage that increases profits relative to their non-PE counterparts. Crucially, the impact on consumer welfare is nuanced: in the short run, consumers benefit from more favorably priced products. But the arbitrage strategy also exposes them to more risk, as annual expected losses scaled by capital buffers rise by 50 percentage points. This creates the possibility of consumer harm in the event of a downturn.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Identification of CD64 as a marker for the destructive potential of synovitis in osteoarthritis
Authors: Teunissen van Manen Iris J , van Kooten Nienke J T , Di Ceglie Irene , Theeuwes Wessel F , Jimenez-Royo Pilar , Cleveland Matthew , van Lent Peter L E M , van der Kraan Peter M , Blom Arjen B , van den Bosch Martijn H J
Published: July 2023

Objectives

OA is characterized by cartilage degeneration and persistent pain. The majority of OA patients present with synovitis, which is associated with increased cartilage damage. Activated synovial macrophages are key contributors to joint destruction. Therefore, a marker that reflects the activation of these cells could be a valuable tool to characterize the destructive potential of synovitis and benefit monitoring of OA. Here, we aimed to investigate the use of CD64 (FcγRI) as a marker to characterize the damaging potential of synovitis in OA.

Methods

Synovial biopsies were obtained from end-stage OA patients that underwent joint replacement surgery. CD64 protein expression and localization was evaluated using immunohistochemistry and immunofluorescence and quantified using flow cytometry. qPCR was performed to measure the expression of FCGR1 and OA-related genes in synovial biopsies, and in primary chondrocytes and primary fibroblasts stimulated with OA conditioned medium (OAS-CM).

Results

Our data exposed a wide range of CD64 expression in OA synovium and showed positive correlations between FCGR1 and S100A8, S100A9, IL1B, IL6 and MMP1/2/3/9/13 expression. CD64 protein correlated with MMP1, MMP3, MMP9, MMP13 and S100A9. Furthermore, we observed that synovial CD64 protein levels in source tissue for OAS-CM significantly associated with the OAS-CM-induced expression of MMP1, MMP3 and especially ADAMTS4 in cultured fibroblasts, but not chondrocytes.

Conclusion

Together, these results indicate that synovial CD64 expression is associated with the expression of proteolytic enzymes and inflammatory markers related to structural damage in OA. CD64 therefore holds promise as marker to characterize the damaging potential of synovitis.
The COMPARE head-to-head, randomized controlled trial of SEL-212 (pegadricase plus rapamycin-containing nanoparticle, ImmTOR™) versus pegloticase for refractory gout
Authors: Baraf Herbert S B , Khanna Puja P , Kivitz Alan J , Strand Vibeke , Choi Hyon K , Terkeltaub Robert , Dalbeth Nicola , DeHaan Wesley , Azeem Rehan , Traber Peter G , Keenan Robert T
Published: July 2023

Objectives

Serum urate (SU) lowering with PEGylated uricases in gout can reduce flares and tophi. However, treatment-emergent anti-drug antibodies adversely affect safety and efficacy and the currently approved PEGylated uricase pegloticase requires twice-monthly infusions. Investigational SEL-212 therapy aims to promote uricase-specific tolerance via monthly sequential infusions of a proprietary rapamycin-containing nanoparticle (ImmTOR) and pegadricase.

Methods

COMPARE was a randomized, phase 2, open-label trial of SEL-212 vs pegloticase in adults with refractory gout. SEL-212 [ImmTOR (0.15 mg/kg) and pegadricase (0.2 mg/kg)] was infused monthly or pegloticase (8 mg) twice monthly for 6 months. The primary endpoint was the proportion of participants with SU <6 mg/dl for ≥80% of the time during 3 and 6 months. Secondary outcomes were mean SU, gout flares, number of tender and/or swollen joints and safety.

Results

During months 3 and 6 combined, numerically more participants achieved and maintained a SU <6 mg/dl for ≥80% of the time with SEL-212 vs pegloticase (53.0% vs 46.0%, P = 0.181). The percentage reductions in SU levels were statistically greater during months 3 and 6 with SEL-212 vs pegloticase (−73.79% and −47.96%, P = 0.0161). Reductions in gout flare incidence and number of tender and/or swollen joints were comparable between treatments. There were numerical differences between the most common treatment-related adverse events of interest with SEL-212 and pegloticase: gout flares (60.2% vs 50.6%), infections (25.3% vs 18.4%) and infusion-related reactions (15.7% vs 11.5%), respectively. Stomatitis (and related terms) was experienced by eight participants (9.6%) with SEL-212 and none with pegloticase. Stomatitis, a known event for rapamycin, was associated with ImmTOR only.

Conclusions

SEL-212 efficacy and tolerability were comparable to pegloticase in refractory gout. This was associated with a substantial reduction in treatment burden with SEL-212 due to decreased infusion frequency vs pegloticase.

Clinical trial registration

NCT03905512.
A Mixed-Methods Study of the Experiences of Black, Indigenous, and People of Color MSW Students during the COVID-19 Pandemic
Authors: Maglalang Dale Dagar , Harris Abril N , Tucker Ty B , Parchment Tyrone M
Published: July 2023

Few studies have explored the experiences of Black, Indigenous, and people of color (BIPOC) MSW students during the pandemic. The purpose of this mixed-methods study was to examine the experiences of BIPOC MSW students in a predominantly white institution in the Northeast during the pandemic and how it affected their mental health. Findings presented were drawn from 29 students who participated in online surveys and focus groups. About 69% of our sample experienced psychological distress, with higher proportions among those who identified as Latine/Latinx, womxn, straight, first-generation, full-time and part-time students, and clinical students. Qualitative findings highlighted three main themes: (1) the experiences and needs of white MSW students were prioritized, (2) inconsistencies in the response to the pandemic forced students to advocate for themselves in their classes and field placements, and (3) virtual learning provided a reprieve for students from experiencing racism that helped improve their perceived well-being. Findings indicate that MSW programs need to commit to acknowledging how systemic racism affects the learning experiences of BIPOC MSW students, work toward dismantling these oppressive structures, and allocate resources that center the health and well-being of BIPOC students and their lived experiences.
Recovery Capital Correlates With Less Methamphetamine Use and Crime in the Community
Authors: Bormann Nicholas L. , Weber Andrea N. , Miskle Benjamin , Arndt Stephan , Lynch Alison C.
Published: July 2023

Objectives

Reentry postcorrectional involvement is a high-risk time for patients with a history of addiction. We investigated whether participation in an addiction medicine clinic with active case management led to improvements in patients' recovery capital and whether there were associated changes in criminal activity and co-occurring methamphetamine or alcohol use.

Methods

Participants (n = 136) were patients with an opioid or stimulant use disorder who had Department of Corrections involvement in the preceding year, who completed the Assessment of Recovery Capital (ARC) and reported criminal activity and days of methamphetamine or alcohol use twice over a 6-month study. Three logistic regression models were used to assess changes in total ARC with criminal activity, alcohol use, and methamphetamine use over the previous 30 days.

Results

Baseline mean (SD) ARC scores were 34.1 (11.1) and increased to a mean (SD) score of 40.3 (9.4) at study end. A 1-SD shift in ARC was significantly protective across outcomes, with adjusted odds ratios of 0.32, 0.18, and 0.34 for any past 30-day criminal activity, alcohol use, or methamphetamine use. There was no significant difference in baseline ARC, crimes committed, days of alcohol use, or days of methamphetamine use for study completers versus noncompleters; however, unmeasured confounders may have had a differential impact on retention.

Conclusions

Recovery capital provides an additional framework to help address patients' substance use and criminal activity in a multifaceted way, which is especially important in the postincarceration community. Recovery capital is dynamic and has multiple areas to target psychosocial interventions.
Dorsal Impaction Injuries of the Distal Radius: Operative Technique Through Dorsal Approach to the Wrist
Authors: Labrum Joseph T. , Moreno Diaz Andres F. , Davis Max E. , Yong Taylor M. , Obremskey William T.
Published: July 2023

Distal radius fractures vary widely in fracture pattern and displacement. Impaction injuries involving the dorsal articular surface of the distal radius can present challenges when anatomic reduction and fixation is attempted through a standard volar approach. Dorsal approach to the distal radius can provide direct visualization of these fracture patterns, greatly facilitating anatomic reduction and stabilization. In this technique video, surgical approach, fracture reduction, and operative fixation of a dorsally impacted, intra-articular distal radius fracture through a dorsal approach is presented. Low-profile dorsal plating can be a safe and effective technique in treating amenable distal radius fractures, with satisfactory radiographic and clinical outcomes. Although this technique provides excellent exposure and facilitates anatomic reduction, surgeons should be aware of associated risks of wrist stiffness and extensor tendon irritation and select low-profile constructs to mitigate these risks.
Acute Total Hip Replacement for Geriatric Acetabular Fracture: Anterior Intrapelvic Approach + Posterolateral Approach
Authors: Solasz Sara , Ganta Abhishek , Egol Kenneth A. , Konda Sanjit R.
Published: July 2023

This review describes the indications and technique for acute total hip arthroplasty in an incomplete both-column acetabular fracture in a geriatric patient.
Tibiotalocalcaneal Arthrodesis Using Hybrid Plate–Nail Constructs: A Novel Technique for Treatment of Unstable Ankle and Hindfoot Deformities
Authors: Smith Carson J. , Skinner William C. , Bettin Clayton C.
Published: July 2023

Tibiotalocalcaneal (TTC) arthrodesis is a treatment option for several pathologies of the ankle and hindfoot, including acute trauma, posttraumatic arthritis, and Charcot neuroarthropathy. Traditional fixation options for TTC arthrodesis include intramedullary hindfoot nailing or internal fixation with plates and/or screws. In certain patients, either due to poor bone quality, impaired sensation, or concern for noncompliance, more robust fixation may be desired. In such patients, we have used a hybrid plate–nail construct with promising results. This article and the accompanying video demonstrate our technique for TTC arthrodesis using a plate–nail construct and review treatment decisions involved with management of these complex cases.
Prognostic Factors of Function in Nonoperatively Treated Radial Head Fractures – A Prospective Cohort Study
Authors: Pelet Stéphane , Hardy Alexandre , Tremblay Félix , Lechasseur Benoît , Rivard-Cloutier Maude
Published: July 2023

Objectives:

To identify patient-related factors and fracture characteristics influencing the functional outcomes of non-operatively treated radial head fractures and to determine function at one year.

Design:

Prospective cohort study

Setting:

Academic level 1 trauma center

Patients/Participants:

Consecutive isolated radial head fractures fitting the inclusion criteria between May 2013 and July 2016.

Intervention:

Nonoperative treatment of isolated radial head fractures.

Outcome measurements:

Logistic regressions between potential prognostic factors and function assessed with the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder and Hand (DASH) score and Range of Motion (ROM) at 1.5-3-6-12 months.

Results:

114 patients were included (78% Mason I [OTA/AO 2R1B1], 20% Mason II [OTA/AO 2R1B3] and 2% Mason III [OTA/AO 2R1C3]). Mean MEPS and DASH score at the last follow-up were excellent [96.4 ± 7.6 and 3.7 ± 8.6] with respectively 79.8% and 92.7% of satisfactory results. Depressive symptoms at injury baseline (Quick Inventory of Depressive Symptomatology > 5) are a constant predictor of unsatisfactory function (MEPS <90 or DASH >17]). Older age and female sex were all linked to worse function at the first follow-ups (p <0.05), whereas lower socioeconomic class and receiving financial compensations were associated to unsatisfactory function at 1-year (p <0.05).

Conclusions:

While most non-operatively treated radial head fractures heal with excellent function, some patients still exhibit unsatisfactory results at 1-year. Symptoms of depression at injury baseline are a constant and significant predictor of unsatisfactory function. Early detection of depressive symptoms would allow interventions that may optimize function.
Navigated Hybrid Open/Muscle-sparing Approach to 2-level Cement Augmentation of the UIV and UIV+1 for Prevention of Proximal Junctional Failure
Authors: Goodarzi Amir , Arora Ayush , Burch Shane , Clark Aaron J. , Theologis Alekos A.
Published: July 2023

Study Design:

Operative video and supplemental manuscript.

Objective:

To present a cement augmentation technique of the upper instrumented vertebra (UIV) and UIV+1 for prevention of proximal junctional fractures (PJFs) in multi-level thoracolumbar posterior instrumented fusions.

Summary of Background Data:

PJFs are unfortunately a common occurrence after multi-level thoracolumbar instrumented fusions to the pelvis for adult spinal deformity that can result in significant functional disability and often require costly revision operations. As such, their prevention is key.

Methods:

A surgical video illustrates the nuances of a 2-level cement augmentation technique, consisting of an open vertebroplasty of the UIV through fenestrated screws and a muscle-sparing kyphoplasty of the UIV+1.

Results:

Utility of performing an open vertebroplasty of the UIV through fenestrated screws and muscle-sparing kyphoplasty of the UIV+1 lies in its ability to minimize soft-tissue disruption at the adjacent segment while providing additional structural support to the anterior column at this high-risk zone.

Conclusions:

Cement augmentation of the UIV and UIV+1 consisting of a hybrid open vertebroplasty and muscle-sparing kyphoplasty can be an effective strategy to decrease the incidence of PJF after multi-level posterior thoracolumbar instrumented fusions to the pelvis for adult spinal deformity.
Scoliosis in Adolescent Patients With Down Syndrome
Authors: Egea-Gámez Rosa M. , Galán-Olleros María , Martínez-Caballero Ignacio , Ramírez-Barragán Ana , Serrano Jose I. , Palazón-Quevedo Ángel , González-Díaz Rafael
Published: July 2023

Study Design:

This is a retrospective, observational comparative study.

Objective:

The aim of this study is to determine whether a relationship exists between the functional level and spinal deformity in patients with Down syndrome (DS).

Summary of Background Data:

Patients with DS have a higher incidence of scoliosis than the general population; however, it is unknown whether functional level influences the characteristics and severity of the deformity.

Materials and Methods:

Of 649 patients with DS included in a pediatric referral center database, we identified 59 with a diagnosis of scoliosis (59.32% female; mean age, 14.19±1.82 y); the 46 patients who met the inclusion criteria comprised the study cohort. According to their functional gait skills and gross motor skills, they were classified into 2 levels. Different coronal and sagittal parameters were measured using full-spine standing radiographs. The need for surgical treatment and history of thoracotomy were recorded as well. Finally, a multivariate association analysis was performed between radiologic parameters and functional level.

Results:

Twenty-two patients had a functional level consistent with level I and 24 with level II. Twelve curves were thoracic, 10 thoracolumbar, and 24 lumbar. A statistically significant relationship was found between functional level I and II and curve magnitude: 18.9 degrees (6.8) versus 36.9 degrees (20.3) (P=0.001) with a cutoff point at 22.3 degrees (area under the curve=0.919, P<0.005, sensitivity=0.917 and specificity=0.818). The relationship between patients who required surgery and level II was also significant (P=0.016). No relationship was found between functional level and coronal and sagittal balance, nor with other radiologic parameters or with curve location, or between the history of thoracotomy and thoracic curves.

Conclusions:

DS adolescents with poorer functional level were associated with larger curves and greater risk for surgery. These findings may provide valuable guidance for the follow-up of scoliosis in patients with DS based on their functional level.

Level of Evidence:

Level III—retrospective comparative study.
Causes of Death Among Medical ICU Patients With Pneumonia Due to COVID-19 in a Safety-Net Hospital
Authors: Cannizzo Joseph P. , Chai Audrey L. , Do Christopher T. , Wilson Melissa L. , Liebler Janice M. , Huerta Luis E.
Published: July 2023

OBJECTIVES:

We sought to identify the primary causes of death of adult patients admitted to the medical ICU with symptomatic COVID-19 who ultimately suffered in-hospital mortality over the span of three major waves of COVID-19: Wild-type, alpha/epsilon, and delta.

DESIGN:

Retrospective single-center cohort study from March 2020 to December 2021.

SETTING:

One medical ICU in a 600-bed Tertiary Care Hospital in Los Angeles, CA.

PATIENTS:

Adult (n = 306) ICU patients admitted with symptomatic COVID-19 who suffered in-hospital mortality.

INTERVENTIONS:

None.

MAIN RESULTS:

Of the 306 patients with COVID-19 who died in the hospital, 86.3% were Hispanic/Latino. The leading cause of death was respiratory failure, occurring in 57.8% of patients. There was no significant change in the rate of pulmonary deaths across the three waves of COVID-19 in our study period. The mean time from symptom onset to admission was 6.5 days, with an average hospital length of stay of 18 days. This did not differ between pulmonary and other causes of death. Sepsis was the second most common cause of death at 23.9% with a significant decrease from the wild-type wave to the delta wave. Among patients with sepsis as the cause of death, 22% (n = 16) were associated with fungemia. There was no significant association between steroid administration and cause of death. Lastly, the alpha/epsilon wave from December 2020 to May 2021 had the highest mortality rate when compared with wild-type or delta waves.

CONCLUSIONS:

We found the primary cause of death in ICU patients with COVID-19 was acute respiratory failure, without significant changes over the span of three waves of COVID-19. This finding contrasts with reported causes of death for patients with non-COVID-19 acute respiratory distress syndrome, in which respiratory failure is an uncommon cause of death. In addition, we identified a subset of patients (5%) who died primarily due to fungemia, providing an area for further investigation.
Tumor immune microenvironment-modulated nanostrategy for the treatment of lung cancer metastasis
Authors: Zhu Lingling , Wu Juan , Gao Honglin , Wang Ting , Xiao Guixiu , Hu Chenggong , Lin Qing , Zhou Qinghua
Published: July 2023

As one of the most malignant tumors worldwide, lung cancer, fueled by metastasis, has shown rising mortality rates. However, effective clinical strategies aimed at preventing metastasis are lacking owing to its dynamic multi-step, complicated, and progressive nature. Immunotherapy has shown promise in treating cancer metastasis by reversing the immunosuppressive network of the tumor microenvironment. However, drug resistance inevitably develops due to inadequate delivery of immunostimulants and an uncontrolled immune response. Consequently, adverse effects occur, such as autoimmunity, from the non-specific immune activation and non-specific inflammation in off-target organs. Nanocarriers that improve drug solubility, permeability, stability, bioavailability, as well as sustained, controlled, and targeted delivery can effectively overcome drug resistance and enhance the therapeutic effect while reducing adverse effects. In particular, nanomedicine-based immunotherapy can be utilized to target tumor metastasis, presenting a promising therapeutic strategy for lung cancer. Nanotechnology strategies that boost the immunotherapy effect are classified based on the metastatic cascade related to the tumor immune microenvironment; the breaking away of primary tumors, circulating tumor cell dissemination, and premetastatic niche formation cause distant secondary site colonization. In this review, we focus on the opportunities and challenges of integrating immunotherapy with nanoparticle formulation to establish nanotechnology-based immunotherapy by modulating the tumor microenvironment for preclinical and clinical applications in the management of patients with metastatic lung cancer. We also discuss prospects for the emerging field and the clinical translation potential of these techniques.
Non-coding RNAs: a promising target for early metastasis intervention
Authors: Xiao Yi , Hu Yijun , Liu Shanrong
Published: July 2023

Metastases account for the overwhelming majority of cancer-associated deaths. The dissemination of cancer cells from the primary tumor to distant organs involves a complex process known as the invasion–metastasis cascade. The underlying biological mechanisms of metastasis, however, remain largely elusive. Recently, the discovery and characterization of non-coding RNAs (ncRNAs) have revealed the diversity of their regulatory roles, especially as key contributors throughout the metastatic cascade. Here, we review recent progress in how three major types of ncRNAs (microRNAs, long non-coding RNAs, and circular RNAs) are involved in the multistep procedure of metastasis. We further examine interactions among the three ncRNAs as well as current progress in their regulatory mechanisms. We also propose the prevention of metastasis in the early stages of cancer progression and discuss current translational studies using ncRNAs as targets for metastasis diagnosis and treatments. These studies provide insights into developing more effective strategies to target metastatic relapse.
The role of insurance status in the association between short-term temperature exposure and myocardial infarction hospitalizations in New York State
Authors: Flores Nina M. , Do Vivian , Rowland Sebastian T. , Casey Joan A. , Kioumourtzoglou Marianthi A.
Published: July 2023

Introduction:

Myocardial infarction (MI) is a leading cause of morbidity and mortality in the United States and its risk increases with extreme temperatures. Climate change causes variability in weather patterns, including extreme temperature events that disproportionately affect socioeconomically disadvantaged communities. Many studies on the health effects of extreme temperatures have considered community-level socioeconomic disadvantage.

Objectives:

To evaluate effect modification of the relationship between short-term ambient temperature and MI, by individual-level insurance status (insured vs. uninsured).

Methods:

We identified MI hospitalizations and insurance status across New York State (NYS) hospitals from 1995 to 2015 in the New York Department of Health Statewide Planning and Research Cooperative System database, using International Classification of Diseases codes. We linked short-term ambient temperature (averaging the 6 hours preceding the event [MI hospitalization]) or nonevent control period in patient residential zip codes. We employed a time-stratified case-crossover study design for both insured and uninsured strata, and then compared the group-specific rate ratios.

Results:

Over the study period, there were 1,095,051 primary MI admissions, 966,475 (88%) among insured patients. During extremely cold temperatures (<5.8 °C) insured patients experienced reduced rates of MI; this was not observed among the uninsured counterparts. At warmer temperatures starting at the 65th percentile (15.7 °C), uninsured patients had higher rates than insured patients (e.g., for a 6-hour pre-event average temperature increase from the median to the 75th percentile, the rate of MI increased was 2.0% [0.0%–4.0%] higher in uninsured group).

Conclusions:

Uninsured individuals may face disproportionate rates of MI hospitalization during extreme temperatures.
Pharmacological interactions and menopausal hormone therapy: a review
Authors: Fasero Maria , Quereda Francisco , Andraca Leire , Coronado Pluvio J. ,   HT Eligibility Criteria Group
Published: July 2023

Importance and Objective

Menopausal hormone therapy (HT) is widely used, and there are several statements of international scientific societies to guide prescribers; however, a summary of existing literature about possible drug interactions with HT does not exist, although many midlife women take medications for other conditions. Therefore, our objective was to create a document that presents and synthesizes the most relevant interactions. The impact of the interaction itself and the number of candidates for HT who are likely to use other treatments are considered based on the best available evidence.

Methods

A systematic review was performed to determine the best evidence of interaction effects on relevant outcomes of interest for decision making. A working framework was developed to formulate explicit and reasoned recommendations according to four predefined categories for coadministration: (1) can be used without expected risks, (2) acceptable use (no evidence of negative interaction), (3) alternative treatment should be considered, and (4) nonuse without express justification. The project protocol was registered in the Open Science Framework platform (doi: 10.17605/OSF.IO/J6WBC) and in PROSPERO (registration number CRD42020166658).

Results

Studies targeting our objective are scarce, but 23 pharmacological groups were assigned to one of the predefined categories of recommendation for concomitant use of HT. Vaginal HT was assigned to category 1 for 21 of the analyzed pharmacological groups. For oral and transdermal HT (estrogen-only or combined) and tibolone, there were 12 pharmacological groups assigned to category 1, 12 to category 2, 5 to category 3, and 4 to category 4. Results are shown in crossed-tables that are useful for counseling and prescription.

Discussion and conclusions

Available evidence of HT interactions with other drugs is scarce and mainly indirect. It comes from biological plausibility, knowledge of extensive concomitant use without reported incidents, and/or extrapolation from hormonal contraception, but there are pharmacological groups in all categories showing that information is useful. These eligibility criteria summarize it and can help in the decision process of HT coadministration with other drugs. Decisions should be taken based on these recommendations but also individualized risk/benefit evaluation, according to underlying pathology, patient's clinical requirements, and the existence or nonexistence of alternatives.
RETINAL DIALYSIS AND ASSOCIATED RHEGMATOGENOUS RETINAL DETACHMENT IN PATIENTS WITH NEUROFIBROMATOSIS TYPE 1: A CASE SERIES
Authors: Shah Ronak M. , Vora Robin A. , Patel Amar P.
Published: July 2023

Purpose:

Although ophthalmic manifestations of neurofibromatosis Type 1 (NF1), including iris Lisch nodules and optic gliomas, have been well described, retinal involvement in these patients has yet to be established. Characterizing the relationship between NF1 and the retina is necessary to optimize outcomes for these patients.

Methods:

Independent chart review of NF1 patients was conducted.

Results:

Chart review yielded four patients, with a history of NF1, with subsequent retinal dialysis and rhegmatogenous retinal detachment. These four patients presented to our institution with a rhegmatogenous retinal detachment secondary to a retinal dialysis with no history of trauma. These patients also demonstrated hyperreflective choroidal abnormalities on near-infrared reflectance imaging and optical coherence tomography.

Conclusion:

Seeing that patients diagnosed with NF1 are susceptible to various ocular manifestations and pathological abnormalities, routine ophthalmic examinations are essential in maintaining their ocular health and minimizing morbidity.
The Relation of the Anterior Ethmoidal Foramen to the Cranial Base
Authors: Cunha Barbara Salomao A. , Garcia Denny Marcos , Cruz Antonio Augusto V.
Published: July 2023

Purpose:

To perform a radiological analysis of the relation of the anterior ethmoidal foramen (AEF) to the cranial base and olfactory fossa (OF).

Methods:

Retrospective analysis of computed tomography coronal scans of 35 orbits of 35 patients with Graves orbitopathy. Following a standard multiplanar reconstruction of the orbit, the authors measured the vertical and the horizontal distances of the AEF to the cranial base and to the lateral border of the OF, respectively. The height of the OF was measured at the level of the AEF and at the position of Keros classification. The presence of supraorbital ethmoid cells (SOEC) was also recorded.

Results:

The vertical distance of the AEF to the cranial base ranged from 0.1 to 7.3 mm with a mean = 2.5 mm (SD = 2.17). In 47.5% of the orbits the foramen was adjacent (<1 mm) to the cranial base. The horizontal distance of the AEF to the lateral border of the OF ranged from 2.3 to 9.5 mm (mean = 5.4 mm, SD = 1.98). The presence of an SOEC (n = 12) increased significantly both the distance from the AEF to the cranial base and to the lateral border of the OF. The height of the OF at the level of AEF is not correlated with the depth of the OF at the level of Keros classification.

Conclusions:

In the absence of supraorbital pneumatization, the AEF location is a dangerous landmark for the upper limit of the transconjunctival medial wall decompression.
Prevalence and Impact of Poststroke Fatigue on Patient Outcomes in the First 6 Months After Stroke: A Systematic Review and Meta-analysis
Authors: Paudel Sulochana Koirala , Rolls Kaye , Green Heidi , Fernandez Ritin
Published: July 2023

BACKGROUND:Post-stroke fatigue (PSF) is one of the most pervasive and debilitating symptoms after stroke and has a negative impact on activities of daily living (ADLs) and health-related quality of life (HRQoL) of stroke survivors. However, to date, no study has systematically reviewed the prevalence of PSF at different points in time after stroke.OBJECTIVE:The aim of this study was to investigate the prevalence of PSF and its impact on ADLs and HRQoL in the first 6 months post stroke.METHOD:CINAHL, MEDLINE, Scopus, Google Scholar, and Index to Theses were searched from 1983 to August 2022 for studies published in English. Studies were included if they were conducted on adults 18 years and older, and were observational, correlational, and quantitative components of mixed methods reporting on PSF, ADLs, and HRQoL post stroke.RESULTS:Thirty studies were included in this review, and all had a high methodological quality. The pooled prevalence of PSF at 1 to 6 weeks was 49.5%; at 3 months, it was 41.9%; and at 6 months, it was 43.4%. A negative correlation between PSF and ADLs was observed at 1, 2, and 4 to 6 weeks, and at 3 and 6 months post stroke. A significant negative correlation between PSF and HRQoL was observed within the first week (r= −0.40,P< .05) and at 3 and 6 months post stroke. The results at 3 and 6 months post stroke were inclusive.CONCLUSION: The prevalence of PSF in the first 6 weeks, particularly in the first 2 weeks after stroke, is high and has a significant negative impact on stroke survivors' ADLs and HRQoL. Only a limited number of studies assessed PSF within the first 2 weeks after stroke.
Evaluating the Usability and Equivalence of Electronic Patient-Reported Outcome Measures for Individuals with a Lower-Limb Amputation
Authors: Maronati Rachel , Rigot Stephanie K. , Mummidisetty Chaithanya K. , Jayaraman Chandrasekaran , Hoppe-Ludwig Shenan , Jayaraman Arun
Published: July 2023

Introduction

Electronic versions of patient-reported outcome measures (PROMs) seem to have a clear administrative logging advantage to traditional paper versions. However, most of them have not been formally evaluated for their suitability to replace paper outcome measures for assessment of individuals with lower-limb amputations. The aim of this study is to examine the usability and equivalence of electronic to paper versions of PROMs suitable for use in prosthetic clinical care and research for persons with lower-limb loss.

Methods

In this cross-sectional study, 10 participants remotely completed the following PROMs online and then on paper: Orthotic and Prosthetic User Survey (OPUS), Modified Falls Efficacy Scale (MFES), Prosthetic Evaluation Questionnaire (PEQ), Patient Health Questionnaire–9 (PHQ-9), and Community Participation Indicators (CPI). Participants also answered open-ended and standardized questions regarding the usability of the electronic surveys. Wilcoxon signed rank tests, comparisons to minimum detectable change, intraclass correlation coefficients, and Bland-Altman plots were used to evaluate differences between the two survey versions, meaningful changes in scores, reliability, and systematic biases, respectively.

Results

Electronic surveys had fewer missing or ambiguous responses than paper surveys; however, the PEQ Social Burdens subscale could not be evaluated due to error in the creation of the electronic survey. No significant differences were found between scores of the two versions for any of the measures, but multiple participants had meaningful changes in the Appearance and Sounds PEQ subscales. All measures demonstrated acceptable reliability between versions, except the Appearance, Perceived Response, and Sounds subscales of the PEQ. No systematic biases in scores or usability concerns were found for any measures.

Conclusions

This study analysis showed that most of the electronic PROMs studied are easily used and demonstrate equivalence to the paper versions. However, the PEQ Appearance, Perceived Response, Sounds, and Social Burden subscales require further evaluation.

Clinical Relevance

Except for the PEQ, electronic versions of the PROMs in this study can likely be used interchangeably with paper versions among individuals with lower-limb loss.
Inhibition of SK2 and ER stress ameliorated inflammation and apoptosis in liver ischemia-reperfusion injury
Authors: Jiang Yiya , Huang Zhaoshuai , Li Xianpeng , Zhou Liuzhi , Zhu Xiuping , Chen Feng , Shi Yanjun
Published: July 2023

Ischemia-reperfusion injury (IRI) remains a major cause of mortality and morbidity after liver surgery. Endoplasmic reticulum (ER) stress is a critical mechanism of inflammatory injury during hepatic IRI. In this study, we investigated the effect of sphingosine kinases 2 (SK2) on ER stress and hepatic IRI. We established hepatic IRI mice and hepatocellular hypoxia/reoxygenation in vitro model. We observed the SK2 and ER stress protein IRE1α expression. Then, we used an SK2 inhibitor and knocked down IRE1α/SK2, to observe the effect of SK2 during IRI. Our results showed that the expression of ER stress and SK2 was significantly elevated during hepatic IRI. Inhibition of SK2 ameliorated liver inflammation and reduced cell apoptosis in hepatic IRI mice. Consistently, we found that the inhibition of IRE1α also downregulated SK2 expression and reduced mitochondrial membrane permeability. Furthermore, the knockdown of SK2 could also reduce cell damage and reduce the expression of inflammatory factors but did not influence ER stress-related signaling pathway. Taken together, our results suggested that ER stress and SK2 played important and regulatory roles in hepatic IRI. Inhibition of ER stress and SK2 could significantly improve liver function after hepatic IRI.
Presbycusis and Hearing Preservation in Observed Vestibular Schwannomas
Authors: Brennan Julia R. , Sharma Rahul , Lindquist Nathan R. , Cass Nathan D. , Krishnapura Shreyas G. , Kloosterman Nicole , Perkins Elizabeth , Bennett Marc L. , O'Malley Matthew R. , Haynes David S. , Tawfik Kareem O.
Published: July 2023

Objective

We reviewed a cohort of patients with untreated sporadic vestibular schwannoma (VS) and examined the relationship between high-frequency hearing loss (HFHL) in the non-VS ear and long-term hearing outcomes in the VS-affected ear. We hypothesized that the progression of HFHL is associated with accelerated hearing decline in sporadic VS.

Study Design

Retrospective cohort study.

Setting

Tertiary center.

Patients

We studied 102 patients with sporadic VS diagnosed from 1999 to 2015 with ≥5 years of observation (median, 6.92; interquartile range, 5.85–9.29). Sixty-six patients had AAO-HNS class A/B hearing at presentation and were included in analysis.

Interventions

Audiometry, serial magnetic resonance imaging for observation of VS.

Main Outcome Measures

Four-frequency pure tone average (PTA) and word recognition scores (WRS) in the VS-affected ear. Decline in high-frequency PTA (average of thresholds at 4000, 6000, and 8,000 Hz) was defined as ≥10 dB during the study period. Decline in WRS was defined as ≥10%.

Results

Compared with those without, patients with progressive HFHL in the non-VS ear were more likely to experience a decline in WRS in the VS ear (80% vs. 54%, p = 0.031). However, the same group showed no difference (52% vs. 41%, p = 0.40) in decline in PTA of the VS ear.

Conclusions

Patients with observed VS who experience progressive HFHL in the non-VS ear are more likely to experience significant declines in speech understanding in the VS-affected ear over time. Patients with a history of presbycusis may have an increased risk of losing serviceable hearing because of sporadic VS.
Evaluating the Efficacy and Pharmacoeconomics of Semaglutide and Tirzepatide in the Setting of Obesity
Authors: Nguyen Timothy , Wong Elaine , Cope Rebecca
Published: July 2023

Background:

Obesity is a major and growing public health concern. The associated cost for obesity and its related comorbidities is approximately 30% of US health care expenditures annually. As additional pharmacotherapeutic options join the market to combat obesity, it is important to understand the financial impact it may have on overall health care costs. This article explores the efficacy and pharmacoeconomics of incretin mimetics, semaglutide and tirzepatide, in the setting of obesity.

Area of Uncertainty:

The cost of incretin mimetics (semaglutide and tirzepatide) and its overall impact on obesity management within the health care arena is being explored. The cost comparison of these medications is to be determined; however, it may represent an added cost to the total US health care expenditures.

Data Sources:

A PubMed and Google Scholar search was conducted using various search terms (eg, semaglutide, tirzepatide, pharmacoeconomics, and obesity).

Therapeutic Advances:

Based on the data reviewed, both semaglutide and tirzepatide are effective medication options for obesity management. Obesity-related management expenditures exceed $173 billion for the US health care system annually. The cost needed to treat for 1% of weight loss with semaglutide and tirzepatide was reported as $1845 and $985, respectively. More than 40% of adults (60 years or older) experience obesity. If 1%, 5%, or 10% of this population is treated with semaglutide, the annual Medicare costs will translate to excess of $2.6 billion, $13.3 billion, and $26.8 billion, respectively. Tirzepatide is not yet approved in the United States for obesity and its financial impact remains to be seen.

Conclusions:

Obesity is associated with burdensome health complications and costs. Semaglutide and tirzepatide are effective drug options for the management of obesity. The cost of these medications will no doubt present a challenge to the total health care expenditures, although the cost–benefit ratio may ultimately be favorable.
Daridorexant, an Orexin Receptor Antagonist for the Management of Insomnia
Authors: Najib Jadwiga , Toderika Yuliana , Dima Lorena
Published: July 2023

Background:

Insomnia is a common sleep disorder that is diagnosed primarily by patients' subjective reported symptoms. Daridorexant is a new dual orexin receptor antagonist that was recently approved by Food and Drug Administration for insomnia characterized by difficulty falling asleep and/or maintaining sleep.

Mechanism of Action, Pharmacodynamics, and Pharmacokinetics:

The orexin neuropeptide signaling system plays a role in wakefulness, and blocking the wake-promoting neuropeptides results in diminished wake signaling, thus exerting a sedative effect using an entirely different mechanism of action than the classical sleep promoting agents. The drug has quick onset of action, high volume of distribution, and high protein binding. Pharmacokinetics and pharmacodynamic parameters were similar in patients of different sex and age and were not significantly affected by race, body size, or mild-to-moderate kidney impairment. Dose limitation to 25 mg in moderate liver impairment and no use in severe liver impairment are recommended. The drug undergoes hepatic CYP3A4 metabolism; thus, caution with strong CYP3A4 inhibitors and inducers is warranted.

Clinical Trials:

The drug was approved based on phase 3 trials involving study 1 and study 2. Study 1 noted daridorexant at doses of 25 and 50 mg demonstrated a statistically significant improvement in wake time after sleep onset, latency to persistent sleep, and self-reported total sleep time against placebo at months 1 and 3. Similarly in study 2, compared with placebo, the 25 mg dose demonstrated statistically significant improvement in wake time after sleep onset, latency to persistent sleep, and self-reported total sleep time at months 1 and 3. Treatment-emergent adverse events were similar for daridorexant and placebo, with nasopharyngitis and headache most frequently reported.

Therapeutic Advance:

Daridorexant is a novel agent with demonstrated efficacy in sleep onset and maintenance and decrease in daytime sedation. Preliminary results from a 1-year extension study note similar incidences of mild-to-moderate side effects as noted in previous trials. Further studies are needed to establish its place in the pharmacological treatment of insomnia.
Churn in Supplemental Nutrition Assistance Program
Authors: Xie Liyang , O’Connor Jason , Albert Steven , Gary-Webb Tiffany , Sharbaugh Michael , Donohue Julie M. , Ennis Molly , Hutcheson Deborah , Cole Evan S.
Published: July 2023

Background:

The Supplemental Nutrition Assistance Program (SNAP) provides financial assistance to low-income individuals and families to help them purchase food. However, when participants experience short-term disenrollment from the program, known as churn, it can disrupt their health care usage patterns or result in acute health care needs due to the loss of financial benefits and time burden required to reapply for SNAP.

Objective:

The objective of this study was to examine the changes in health care expenditures and acute care utilization during periods of SNAP churn compared with nonchurn periods among those who churn during the study period.

Research Design:

Longitudinal analysis of Pennsylvania Medicaid claims data for enrollees participating in SNAP between 2016 and 2018 using individual fixed-effects models. We add to the literature by estimating whether these changes varied based on the amount of SNAP benefit lost, or differed between adults and children.

Results:

We found that SNAP churn was associated with reductions in pharmacy and primary care spending across all SNAP benefit levels and age groups. Specifically, our findings indicate a reduction of 4%–6% in pharmacy expenditures for adults and 2%–4% for children. Moreover, there was a 3%–4% decrease in primary care expenditures for adults and a 4%–6% decrease for children. Acute care utilization did not significantly change during a SNAP churn period.

Conclusion:

Our findings of decreases in pharmacy and primary care spending suggest that preventing SNAP churn may help reduce instances where adult and child participants forgo necessary care.
The New York Misophonia Scale (NYMS): A New Instrument to Identify Misophonia in the General Population
Authors: Barahmand Usha , Stalias-Mantzikos Maria E. , Xiang Ying , Rotlevi Esther
Published: July 2023

Misophonia is a condition in which certain sounds and behaviors elicit distress that ranges from mild annoyance to disgust or anger. The aim of this research was to develop and validate an instrument to screen for misophonia in the general population. Study 1 developed and explored the factor structure and item quality of the New York Misophonia Scale (NYMS), which originally included 42 triggers and 13 behavioral reactions. A sample of 441 American adults responded to the instrument via social media platforms. Of the original 42 triggers, 25 clustered into 4 factors: repetitive actions, mouth sounds, ambient object sounds, and ambient people sounds. The 13 behavioral reactions loaded on to 2 factors, aggressive and nonaggressive reactions. Study 2 evaluated the psychometric properties of the final version of the NYMS using a sample of 200 American adults. The results supported the validity of the factor structure and the reliability of the final version of the NYMS from Study 1. Finally, Study 3 explored the concurrent and convergent validity of the final version of the NYMS with the Misophonia Questionnaire (MQ) and the Difficulties in Emotion Regulation Scale-Short Form (DERS-SF). A sample of 171 adult participants completed all of the scales. Good concurrent validity was found with the MQ and good convergent validity was found with the DERS-SF. Overall, the NYMS appears to be a useful and promising instrument for assessing misophonia triggers, severity of distress elicited, and behavioral reactions to the distress in the general population.