bluuebunny/crossref_metadata_2025 huggingface dataset:
Monstrous Births, Birth Defects, Unusual Anatomy, and Disability in Europe and North America
Authors: Reagan Leslie J.
Published: September 2022

“Monstrous births,” anomalous newborn bodies, or stillbirths, have produced public and scientific reactions of fear and excited voyeuristic interest from the early modern period to the present in Europe and North America. During this time, the category of “monstrous births” expanded even if the term itself was replaced over time with “defectives,” “congenital malformations,” “birth defects,” and “disabilities.” Particular attention is given here to medicine, mothers of “monstrous births,” twentieth-century moments that brought birth defects to international attention (German measles and thalidomide), and gender. In addition, attention is given to the perspective of contemporary people whose sixteenth- and seventeenth-century predecessors (conjoined twins) were considered “monstrous births” and whose bodies are still preserved in museums.
The Rise of Gay Rights and the Disavowal of Disability in the United States
Authors: Kunzel Regina
Published: September 2022

Homosexuality has a complex history of entwinement with disability, marked most notably by its long-standing designation as a form of mental illness. That attribution was anticipated by nineteenth-century sexologists and promoted by mid-twentieth-century psychiatrists. In the years that followed, gay and lesbian activists worked to distance themselves from that stigmatizing association, successfully lobbying to remove “homosexuality” from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1973. Revisited here is the history of the gay liberationist battle against the psychiatric establishment as viewed through the analytical lenses offered by critical disability studies and disability history. Also tracked are the exclusionary and stigmatizing effects of the insistence on homosexuality as “healthy.”
Disabled Veterans and the Wounds of War
Authors: Gerber David A.
Published: September 2022

War is an abiding cause of death, disability, and disease. Disabled and chronically ill veterans of military conflict, as well as civilian victims of wars, have been neglected, both in popular memories and in academic research. But as long as people find disabled veterans convenient symbols of patriotism and sacrifice, they will continue to be a special project of the state, with a unique status separate from nondisabled and disabled civilians. Though there is still no synthesis of the history of disabled veterans, the outlines of one have been taking shape, emphasizing (1) the evolving nature of injuries to bodies and minds in the contexts of warfare, weaponry, and military medicine; (2) military citizenship; (3) identity; and (4) cultural representations.
The salience of choice reduces social responsibility: evidence from lab experiments and compliance with COVID-19 stay-at-home orders
Authors: Wang Yan , Savani Krishna
Published: September 2022

The tension between self-interest and the collective good is fundamental to human societies. We propose that the idea of choice is a key lever that nudges people to act in a self-interested manner because it leads people to value independence. Making one inconsequential choice at the beginning of an incentive-compatible lab experiment made people 41% more likely to choose a monetary allocation that maximized their own payoff while minimizing the total payoff of their group (Studies 1A and 1B). The next two studies featured seven-participant experimental markets in which sellers decided whether to produce conventional goods (which imposed costs on others) or socially responsible goods (which did not impose any costs), and buyers decided which goods to purchase. In markets in which members made a single inconsequential choice, the market share of the socially responsible good was reduced by a factor of 34% (Studies 2A and 2B). In the context of the COVID-19 pandemic, framing socially responsible actions as choices increased people’s willingness to hoard and violate social distancing rules (Study 3). Highlighting the idea of choice reduced people’s desire to engage in corporate social responsibility, and this effect was mediated by an increased emphasis on independence (Study 4). Finally, using cell phone location data, an archival study found that in states in which people were more likely to search for choice-related words on the internet in 2019, residents were more likely to leave their homes following a stay-at-home order, after controlling for state-level income, education, diversity, population density, and political orientation (Study 5).
Soft dipole resonance in neutron-rich 8He
Authors: Myo Takayuki , Odsuren Myagmarjav , Katō Kiyoshi
Published: September 2022

In neutron-rich 8He, we study the soft dipole resonance, which is regarded as a dipole oscillation of four valence neutrons against the 4He core, and its effect on the low-energy electric dipole strength with a 4He+n+n+n+n five-body cluster model. This work is an extended study of an earlier letter [T. Myo and K. Katō, Phys. Rev. C 106, L021302 (2022)]. The five-body unbound 1− states of 8He are obtained with complex-energy eigenvalues by using the complex scaling method and the dipole strength is calculated in terms of the complex-scaled Green’s function. Two kinds of dominant excitation modes are confirmed in the dipole strength below 20 MeV of the excitation energy. The strengths below 10 MeV are exhausted by the 7He+n channel, which sequentially decays to 6He+n+n. Above 10 MeV, the strengths arise from the soft dipole mode of four neutrons (4n) oscillating against the 4He core. We further explore the possibility of the soft dipole resonance for this state by carefully searching for the resonance pole and finally predict the corresponding resonance with the excitation energy of 14 MeV and the decay width of 21 MeV. The soft dipole resonance exhausts about half of the dipole strength in the relative motion between the 4He core and 4n.
Rethinking the Supreme Court’s Impact on American Federalism and Centralization
Authors: Dichio Michael A , Somin Ilya
Published: September 2022

This article challenges the conventional wisdom about of the Supreme Court’s impact on federalism and centralization. In particular, we argue that the centralization impact of the Court is far less pronounced if decisions that uphold federal and state/local laws against challenge are classified as neutral rather than as centralizing and decentralizing, respectively. This reclassification dramatically alters our understanding of the Court’s role in establishing federal–state boundaries of power. After presenting our theoretical arguments, we briefly discuss the potential empirical effects of these revisions. Our analysis calls into question the traditional picture of the Court as a consistent force for centralization. It also challenges the conventional wisdom about the Court’s impact on centralization during specific key periods of American history.
Challenges and Insights From Treating Psychotic Disorders During COVID-19 Pandemic in Brazil
Authors: Gadelha Ary , Cerqueira Raphael de O , Mari Jair , Ziebold Carolina
Published: September 2022

The COVID-19 pandemic mainly affected the most vulnerable individuals. Among those, patients with schizophrenia especially suffered from unexpected changes in their routines, barriers to treatment, and distress-related events. We conducted a narrative review using all available sources of information to describe the challenges faced by schizophrenia patients and their families in Brazil, including the strategies that have been adopted to tackle them. In addition, we analyzed public data on antipsychotic prescriptions and hospitalizations. It was found that digital prescriptions with extended expiration dates implemented during the pandemic in Brazil allowed patients to maintain their access to antipsychotics. Hospitalizations among patients with schizophrenia, schizotypal, and schizoaffective disorders decreased at the beginning of the pandemic. Nevertheless, in the following months, the admissions returned to a trend similar to the prepandemic period. The systematization of online resources will be one of the main legacies to mental health care, including schizophrenia. We believe one of the main limitations of the policies adopted was the decision to not prioritize COVID-19 vaccination in patients with severe psychiatric disorders, despite preliminary evidence of a higher risk of complications in this group. The coronavirus pandemic is still ongoing and a longer time will be required to have a better perspective of its effects, but we expect this record of challenges and insights about the lessons learned during the pandemic can help healthcare professionals to face similar situations in the future.
Predictors of Treatment Completion in an Inpatient Substance Use Treatment Service in India
Authors: Ghosh Abhishek , Sharma Nidhi , Noble Dalton , Basu Debasish , Mattoo S.K. , Nanjayaya Subodh B. , Pillai R.R. , Kaur Simranjit
Published: September 2022

Introduction

Treatment completion is associated with a better outcome in substance use disorders. We examined the rates of treatment completion and its predictors in patients admitted to specialized addiction treatment settings over a 13-year period.

Methods

Ours was a retrospective cohort study. We included consecutive 2850 patients admitted to the inpatient treatment between January 2007 and December 2019. We divided the patients into 2 groups: completed versus premature discontinuation of treatment. The predictor variables were based on previous research, clinical experience, and availability of the digital record.

Results

The number of patients who completed and discontinued treatments was 1873 (72.6%) and 707 (27.4%), respectively. The inpatient treatment discontinuation rate varied widely during the study period (18% in 2007 and 41% in 2012). The average rate of treatment discontinuation was 27%. The change-point analysis showed 5 statistically significant change points in the years 2008, 2010, 2012, 2014, and 2016. Patients who were prescribed medications for alcohol and opioid dependence and those who were on opioid agonist treatment had 4.7 and 6.3 higher odds of completing inpatient treatment than those who were not on medication. Patients with physical and psychiatric comorbidities had higher odds of treatment completion. Patients with a primary diagnosis of opioid dependence had lower odds of treatment completion than those with alcohol dependence.

Conclusions

The rates of discontinuation may vary with concurrent changes in the treatment policies. Awareness of the risk factors and policy measures that may improve treatment completion must aid in informed decision making.
Concerns About Hospital-based Managed Alcohol Programs
Authors: Weaver Michael
Published: September 2022

This case commentary involves a hospital-based managed alcohol program that uses a standardized protocol for administration of beverage alcohol (vodka or beer) in hospitalized patients with alcohol use disorder in an urban hospital in Canada. Issues of concern include addressing alcohol use during hospitalization directly with motivational interviewing instead of permitting consumption of alcohol, dangers of beverage alcohol in hospitalized patients, and risk of worsening alcohol withdrawal syndrome. Ethical principles are also briefly addressed as they apply to managed alcohol programs.
Differences in Self-identification of Opioid Overdose Risk and Naloxone Perceptions Between Therapeutic and Nontherapeutic Opioid Populations
Authors: Ellis Matthew S. , Kasper Zachary A. , Gold Mark , Cicero Theodore J.
Published: September 2022

Objectives

Efforts to improve low naloxone uptake to mitigate the current opioid crisis have included coprescribing naloxone with opioid medications and, more recently, expansion through over-the-counter availability, the latter of which necessitates self-identification of overdose risk by consumers. This study sought to understand perceptions of opioid overdose risk and naloxone among distinct opioid populations at elevated risk for overdose.

Methods

A cross-sectional, online survey was provided to 2 opioid populations in June 2020. First, chronic pain opioid managed (CPOM; n = 190) individuals currently treated with an opioid prescription (either >50 daily morphine milligram equivalents [73.2%] or benzodiazepine co-use [52.6%]), restricted by confounders. Second, individuals with a history of opioid use disorder (OUD; n = 152) previously participating in a national opioid surveillance study of new entrants to substance use treatment centers.

Results

Risk perceptions significantly differed, with 60.0% (CPOM) versus 28.9% (OUD) reporting that they were “not at all concerned about overdosing,” and 62.1% (CPOM) versus 19.1% (OUD) perceiving themselves as having “no risk” of overdose. Perceived need for naloxone was lower among CPOM versus OUD patients (48.3% and 71.8%, respectively), whereas 22.6% and 35.0%, respectively, indicated any likelihood of obtaining naloxone in the future.

Conclusions

Results suggest that a significant proportion of both samples lacked the ability to self-identify their risk of overdose and self-select themselves as needing naloxone, with gaps being more prominent in the CPOM sample. A multi-intervention framework that addresses distinct pathways of behavioral change between unique opioid populations should be considered in conversations surrounding potential transitions to over-the-counter naloxone.
The Frequency of Common Deafness-Associated Variants Among 3,555,336 Newborns in China and 141,456 Individuals Across Seven Populations Worldwide
Authors: Zhang Jiao , Wang Hongyang , Yan Chengbin , Guan Jing , Yin Linwei , Lan Lan , Li Jin , Zhao Lijian , Wang Qiuju
Published: September 2022

Objectives:

Genetic screening can benefit early detection and intervention for hearing loss. The frequency of common deafness-associated variants in general populations is highly important for genetic screening and genetic counseling tailored to different ethnic backgrounds. We aimed to analyze the frequency of common deafness-associated variants in a large population-based Chinese newborn cohort and to explore the population-specific features in diverse populations worldwide.

Design:

This population-based cohort study analyzed the frequency of common deafness-associated variants in 3,555,336 newborns in the Chinese Newborn Concurrent Hearing and Genetic Screening cohort. Participants were newborn infants born between January 2007 and September 2020. Limited genetic screening for 20 variants in 4 common deafness-associated genes and newborn hearing screening were offered concurrently to all newborns in the Chinese Newborn Concurrent Hearing and Genetic Screening cohort. Sequence information of 141,456 individuals was also analyzed from seven ethnic populations from the Genome Aggregation Database for 20 common deafness-related variants. Statistical analysis was performed using R.

Results:

A total of 3,555,326 Chinese neonates completed the Newborn Concurrent Hearing and Genetic Screening were included for analysis. We reported the distinct landscape of common deafness-associated variants in this large population-based cohort. We found that the carrier frequencies of GJB2, SLC26A4, GJB3, and MT-RNR were 2.53%, 2.05%, 0.37%, and 0.25%, respectively. Furthermore, GJB2 c.235delC was the most common variant with an allele frequency of 0.99% in the Chinese newborn population. We also demonstrated nine East-Asia-enriched variants, one Ashkenazi Jewish-enriched variant, and one European/American-enriched variant for hearing loss.

Conclusions:

We showed the distinct landscape of common deafness-associated variants in the Chinese newborn population and provided insights into population-specific features in diverse populations. These data can serve as a powerful resource for otolaryngologists and clinical geneticists to inform population-adjusted genetic screening programs for hearing loss.
Evaluation of the Posterior Tilt Angle in Predicting Failure of Nondisplaced Femoral Neck Fractures After Internal Fixation: A Systematic Review
Authors: Papadelis Efstratios , Chaudhry Yash P. , Hayes Hunter , Talone Christopher , Shah Mitesh P.
Published: September 2022

Objective:

To evaluate the posterior tilt angle (PTA) in predicting treatment failure after internal fixation of nondisplaced femoral neck fractures as graded by the Garden classification, which is based solely on anterior–posterior radiographic evaluation.

Data Sources:

A search was conducted of all published literature in the following databases from inception to December 20, 2021: PubMed, Embase, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov.

Study Selection:

We included English-language randomized controlled trials, prospective and retrospective cohort studies that reported malunion/nonunion, avascular necrosis, fixation failure, or reoperations in patients with nondisplaced femoral neck fractures treated with internal fixation who were evaluated for PTA using either lateral radiograph or computed tomography.

Data Extraction:

All abstract, screening, and quality appraisal was conducted independently by 2 authors. Data from included studies were extracted manually and summarized. The Methodological Index for Non-Randomized Studies criteria was used for quality appraisal.

Data Synthesis:

Odds ratios with 95% confidence intervals were calculated for treatment failure, defined as nonunion/malunion, avascular necrosis, fixation failure, or reoperation, in cases involving preoperative PTA ≥20-degrees and <20-degrees. Statistical significance was set at P < 0.05.

Results:

Nondisplaced femoral neck fractures with PTA >20-degrees had a 24% rate of treatment failure compared with 12% for those <20-degrees [odds ratios, 3.21 (95% confidence intervals, 1.95–5.28); P < 0.001].

Conclusion:

PTA is a predictor of treatment failure in nondisplaced femoral neck fractures treated with internal fixation. Nondisplaced femoral neck fractures with a PTA >20-degrees may warrant alternative treatment modalities.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Predicting the Magnitude of Distal Junctional Kyphosis Following Cervical Deformity Correction
Authors: Ayres Ethan W. , Protopsaltis Themistocles S. , Ani Fares , Lafage Renaud , Walia Arnaav , Mundis Gregory M. , Smith Justin S. , Hamilton D. Kojo , Klineberg Eric O. , Sciubba Daniel M. , Hart Robert A. , Bess Shay , Shaffrey Christopher I. , Schwab Frank J. , Lafage Virginie , Ames Christopher P. ,   the International Spine Study Group (ISSG)
Published: September 2022

Study Design.

Retrospective review of a cervical deformity database.

Objective.

This study aimed to develop a model that can predict the postoperative DJK angle by using pre and post-operative radiographic measurements.

Summary of Background Data.

Distal junctional kyphosis (DJK) is a complication following cervical deformity correction that can reduce of patient quality of life and functional status. Although researchers have identified the risk factors for DJK, no model has been proposed to predict the magnitude of DJK.

Methods.

The DJK angle was defined as the Cobb angle from LIV to LIV-2 with traditional DJK (tDJK) having a DJK angle change >10°. Models were trained using 66.6% of the randomly selected patients and validated in the remaining 33.3%. Pre-and post-operative radiographic parameters associated with DJK were identified and ranked using a conditional variable importance table. Linear regression models were developed using the factors most strongly associated with the postoperative DJK angle.

Results.

131 patients were included with a mean follow-up duration of 14±8 months. The mean postoperative DJK angle was 14.6±14° and occurred in 35% of the patients. No significant differences between the training and validation cohort were observed. The variables most associated with post-operative DJK were: preoperative DJK angle (DJKApre), postoperative C2- lower Instrumented vertebral tilt (C2-LIV), and change in cervical lordosis (∆CL). The model identified the following equation as predictive of DJKA: DJKA=9.365 + (0.123*∆CL) – (0.315* ∆C2-LIV) – (0.054*DJKApre). The predicted and actual postoperative DJKA values were highly correlated (R=0.871, R2=0.759, P<0.001).

Conclusion.

The variables that most increased the DJK angle were the preoperative DJK angle, postoperative alignment within the construct, and change in CL. Future studies can build upon the model developed to be applied in a clinical setting when planning for cervical deformity correction.
NDI <21 Denotes Patient Acceptable Symptom State After Degenerative Cervical Spine Surgery
Authors: Shahi Pratyush , Subramanian Tejas , Singh Nishtha , Shinn Daniel , Dalal Sidhant , Song Junho , Araghi Kasra , Melissaridou Dimitra , Sheha Evan , Dowdell James , Qureshi Sheeraz A. , Iyer Sravisht
Published: September 2022

Study Design.

Retrospective review of prospectively collected data.

Objective.

To determine the Neck Disability Index (NDI) cut-off for achieving patient acceptable symptom state (PASS) at six months following degenerative cervical spine surgery.

Summary of Background Data.

An absolute score denoting PASS might be a better marker to assess clinical outcomes than a change score denoting minimal clinically important difference.

Materials and Methods.

Patients who underwent primary anterior cervical decompression and fusion, cervical disk replacement, or laminectomy were included. The outcome measure was NDI. The anchor used to assess PASS achievement at six months was the response on the Global Rating Change: “Compared with preoperative, you feel (1) much better, (2) slightly better, (3) same, (4) slightly worse, or (5) much worse.” It was converted to a dichotomous outcome variable (acceptable=response of 1 or 2, unacceptable=response of 3, 4, or 5) for analyses. The overall cohort and subgroups based on age (65 yr and below, above 65 yr), sex, myelopathy, and preoperative NDI (≤40, >40) were analyzed for the proportion of patients achieving PASS and the NDI cut-off using receiver operator curve.

Results.

Seventy-five patients (42 anterior cervical decompression and fusion, 23 cervical disc replacement, 10 laminectomy) were included. 79% of patients achieved PASS. Males, patients with age 65 years and below, preoperative NDI ≤40, and absence of myelopathy were more likely to achieve PASS. The receiver operator curve analysis revealed an Oswestry Disability Index cut-off of 21 to achieve PASS (area under the curve, AUC: 0.829, sensitivity: 81%, specificity: 80%). The subgroup analyses based on age, sex, myelopathy, and preoperative NDI revealed AUCs >0.7 and NDI threshold values consistent between 17 and 23.

Conclusions.

With an AUC of 0.829, NDI showed an excellent discriminative ability. Patients with NDI ≤21 are expected to achieve PASS following degenerative cervical spine surgery.
Molecular biomarkers for gestational diabetes mellitus and postpartum diabetes
Authors: Lu Wenqian , Hu Cheng
Published: September 2022

Gestational diabetes mellitus (GDM) is a growing public health problem worldwide that threatens both maternal and fetal health. Identifying individuals at high risk for GDM and diabetes after GDM is particularly useful for early intervention and prevention of disease progression. In the last decades, a number of studies have used metabolomics, genomics, and proteomic approaches to investigate associations between biomolecules and GDM progression. These studies clearly demonstrate that various biomarkers reflect pathological changes in GDM. The established markers have potential use as screening and diagnostic tools in GDM and in postpartum diabetes research. In the present review, we summarize recent studies of metabolites, single-nucleotide polymorphisms, microRNAs, and proteins associated with GDM and its transition to postpartum diabetes, with a focus on their predictive value in screening and diagnosis.
Serum uric acid levels and the risk of diabetes mellitus in premenopausal and postmenopausal women: the Suita study
Authors: Li Jiaqi , Arafa Ahmed , Sheerah Haytham A. , Teramoto Masayuki , Nakao Yoko M. , Honda-Kohmo Kyoko , Kashima Rena , Sakai Yukie , Watanabe Emi , Dohi Tomoharu , Kokubo Yoshihiro
Published: September 2022

Objective

The association between serum uric acid levels and the risk of diabetes mellitus in women stratified by menopausal status is not well-established. Therefore, we investigated this association among a cohort of Japanese urban women.

Methods

We conducted a prospective cohort study on 3,304 women (1,252 premenopausal and 2,052 postmenopausal), aged 30 to 79 years, with no prior cardiovascular disease or diabetes mellitus, and enrolled from a general urban population. Cox proportional hazard model was used to calculate hazard ratios and 95% confidence intervals (CIs) for incident diabetes mellitus according to serum uric acid quartiles.

Results

During 13.8 years of median follow-up, 219 incident diabetes mellitus cases were diagnosed. The incidence rate per 1,000 person-years was 3.42 in premenopausal women and 6.19 in postmenopausal women. After adjustment for potential risk factors, the multivariable hazard ratios (95% CIs) of the highest versus lowest serum uric acid quartiles were 1.56 (0.77-3.16) in premenopausal women, 2.00 (1.19-3.34) in postmenopausal women, and 1.81 (1.21-2.73) in all women. The interaction based on menopausal status was not significant (P = 0.872). The corresponding population attributable fractions (95% CIs) were 13.3% (−8.9% to 31.1%), 19.1% (5.3%-30.9%), and 17.0% (5.6%-27.0%), respectively.

Conclusions

Serum uric acid levels were positively associated with the risk of diabetes mellitus in postmenopausal women, but not in premenopausal women. However, the lack of an association in premenopausal women may have been due to limited power, so further research is required to confirm this menopausal status–specific association.
Self-reported menstrual cycle length during reproductive years in relation to menopausal symptoms at midlife in Project Viva
Authors: Mínguez-Alarcón Lidia , Rifas-Shiman Sheryl L. , Soria-Contreras Diana C. , Hivert Marie-France , Shifren Jan , Oken Emily , Chavarro Jorge E.
Published: September 2022

Objective

The aim of this study was to investigate the extent to which self-reported menstrual cycle length during reproductive years is associated with menopausal symptoms and age at natural menopause at midlife.

Methods

This analysis includes 634 women who enrolled in Project Viva during pregnancy (1999-2002) and completed the midlife visit approximately 18 years later. Women self-reported menstrual cycle length at enrollment (early pregnancy) and at midlife reported total and specific menopausal symptoms using the Menopause Rating Scale as well as age at natural menopause. We used linear and regression models to evaluate associations of cycle length with total and specific menopausal symptoms. We also applied a time-to-event Cox proportional hazards model to investigate the relationship between menstrual cycle length and onset of natural menopause. We adjusted models for age at midlife visit, prepregnancy body mass index, race/ethnicity, education, and parity.

Results

At enrollment (median age, 33.3 years), 90 (14%) women reported having short (≤25 days) and 39 (6%) reported long (≥35 days) menstrual cycles. Compared with women with a normal menstrual cycle length of 26 to 34 days, women whose cycles were short had a higher total Menopause Rating Scale at midlife (β = 2.05; 95% confidence interval [CI], 0.73-3.38). Specifically, women with short menstrual cycles during their reproductive years had higher odds of midlife sleep problems (odds ratio [OR], 1.92; 95% CI, 1.10-3.37), heart discomfort (OR, 1.68; 95% CI, 1.03-2.73), and depressive symptoms (OR, 1.85; 95% CI, 1.16-2.96). In addition, compared with women with a normal cycle length of 26 to 34 days, women reporting short cycles had an earlier onset of natural menopause (hazard ratio, 1.67; 95% CI, 1.11-2.51).

Conclusions

Compared with women with normal menstrual cycle length, those with short menstrual cycles during their reproductive years had a higher frequency of total and certain menopausal symptoms at midlife and reached menopause earlier.
The Hybrid Facelift
Authors: Althubaiti Ghazi A.
Published: September 2022

In facelift surgery, many surgeons tend to choose one superficial musculoaponeurotic system (SMAS) technique over another. SMAS plication augments tissue using folding, which is very useful in deflated faces. In heavy faces, SMAS-ectomy and, to an arguably further extent, full SMAS undermining and excision can reduce volume and avoid the excessive fullness that may follow plication. Not all patients present with uniform deflation or uniform fullness of the face. Some will present with a mixed picture, fullness in one area such as the cheek with deflation in another (eg, over the angle of the mandible). In those patients, plication alone may lead to undesired fullness, typically overaugmenting cheeks or angle of the mandible. SMAS elevation and excision may avoid overaugmentation (arguably better than simple SMAS-ectomy), but it is technically more demanding and consumes longer operative time. An alternative approach is suggested in this article. For those patients with “mixed” pictures, we suggest a hybrid of existing SMAS techniques, in which for each side of the face, the face is divided into upper (cheek) and lower (jawline and neck) areas. Deflated areas are addressed with plication. Full areas are addressed with SMAS undermining and excision. Although this kind of surgical approach might be practiced by some surgeons, it has not been described well in the literature. In a series of 495 facelifts, the author found this “hybrid facelift” technique useful in 61 cases.
Ptosis effects on intraocular lens power calculation
Authors: Aydemir Emre , Aksoy Aydemir Gozde
Published: September 2022

Purpose:

To evaluate quantitatively ocular biometric parameters and intraocular lens (IOL) power measurements after ptosis surgery.

Setting:

Adiyaman University Hospital, Adiyaman, Turkey.

Design:

Comparative prospective clinical study.

Methods:

This study comprised involutional ptosis patients divided into droopy eyelid severity groups: Group 1: >4 mm, Group 2: 3 to 4 mm, and Group 3: 1 to 2 mm. The patients underwent anterior levator resection, and preoperative and postoperative biometry measurements at 3 months postoperatively were obtained.

Results:

The Group 1 sample size was 19, Group 2 was 22, and Group 3 was 16. The mean flattest keratometry (K1), steepest keratometry (K2), and mean keratometry (Km) values significantly decreased at 3 months postoperatively in Group 1 (P < .001 for all). The mean K1, K2, and Km values nonsignificantly decreased at 3 months postoperatively in Groups 2 and 3 (P > .05 for all). The mean corneal astigmatism magnitude decreased at 3 months postoperatively in Group 1 (P < .01), Group 2 (P = .186), and Group 3 (P = .952). The mean recommended IOL powers targeting emmetropia increased postoperatively in Group 1 and were similar preoperatively and postoperatively in Groups 2 and 3. In Group 1, the mean changes after ptosis surgery by the formula were 0.47 diopters (D) for SRK/T, 0.52 D for Hoffer Q, 0.55 D for Haigis, 0.50 D for Barrett Universal II, and 0.55 D for Holladay 2.

Conclusions:

Ptosis >4 mm significantly affects corneal curvature values and IOL power calculations when cataract surgery is planned. Surgeons might consider altering their lens power choice accordingly if cataract surgery is to be sequentially followed by ptosis repair.
Intrinsic and synaptic properties of adult mouse spinoperiaqueductal gray neurons and the influence of neonatal tissue damage
Authors: Li Jie , Serafin Elizabeth K. , Baccei Mark L.
Published: September 2022

The periaqueductal gray (PAG) represents a key target of projection neurons residing in the spinal dorsal horn. In comparison to lamina I spinoparabrachial neurons, little is known about the intrinsic and synaptic properties governing the firing of spino-PAG neurons, or whether such activity is modulated by neonatal injury. In this study, this issue was addressed using ex vivo whole-cell patch clamp recordings from lamina I spino-PAG neurons in adult male and female FVB mice after hindpaw incision at postnatal day (P)3. Spino-PAG neurons were classified as high output, medium output, or low output based on their action potential discharge after dorsal root stimulation. The high-output subgroup exhibited prevalent spontaneous burst firing and displayed initial burst or tonic patterns of intrinsic firing, whereas low-output neurons showed little spontaneous activity. Interestingly, the level of dorsal root–evoked firing significantly correlated with the resting potential and membrane resistance but not with the strength of primary afferent-mediated glutamatergic drive. Neonatal incision failed to alter the pattern of monosynaptic sensory input, with most spino-PAG neurons receiving direct connections from low-threshold C-fibers. Furthermore, primary afferent-evoked glutamatergic input and action potential discharge in adult spino-PAG neurons were unaltered by neonatal surgical injury. Finally, Hebbian long-term potentiation at sensory synapses, which significantly increased afferent-evoked firing, was similar between P3-incised and naive littermates. Collectively, these data suggest that the functional response of lamina I spino-PAG neurons to sensory input is largely governed by their intrinsic membrane properties and appears resistant to the persistent influence of neonatal tissue damage.
Characterizing the Uptake of Newly Opened Health Centers by Individuals Dually Enrolled in Medicare and Medicaid
Authors: Wright Brad , Akiyama Jill , Potter Andrew J. , Sabik Lindsay M. , Stehlin Grace G. , Trivedi Amal N. , Wolinsky Fredric D.
Published: September 2022

Federally qualified health centers (FQHCs) increasingly provide high-quality, cost-effective primary care to individuals dually enrolled in Medicare and Medicaid. However, not everyone can access an FQHC. We used 2012 to 2018 Medicare claims and federally collected FQHC data to examine communities where an FQHC first opened and determine which dual eligibles used it. Overall uptake was 10%, ranging from 6.6% among age-eligible urban residents to 14.8% among disability-eligible rural residents. Community-level uptake ranged from 0% to 76.4% (median = 5.5%; interquartile range = 2.8%-11.3%). Certain subpopulations of dual eligibles are significantly more likely to use FQHCs. Our findings should inform the targeting of future FQHC expansions.
The comparison of different BCG strains in the intravesical treatment of non-muscle invasive urothelial carcinoma of urinary bladder-A real-world practice
Authors: Chen Yu-Kuang , Huang Eric Yi-Hsiu , Chang Yen-Hwa , Kuo Junne-Yih , Chung Hsiao-Jen , Wu Howard Hung-Hao , Lin Tzu-Ping , Lin Chih-Chieh , Fan Yu-Hua , Huang I-Shen , Lin Alex T.L. , Huang William J.
Published: September 2022

Background:

Bacillus Calmette–Guérin (BCG) has been well recognized as the first-line intravesical therapy for high-risk non-muscle-invasive bladder cancer (NMIBC). Oncotice, the Tice strain of BCG, serves as a viable alternative to the Connaught strain owing to the worldwide shortage of the latter. We retrospectively compared these two strains in terms of efficacy and adverse effects (AE) in patients who underwent at least one maintenance course after induction.

Methods:

In this single-institution, retrospective study, patients diagnosed with NMIBC who were administered either Connaught or Tice intravesical therapy were enrolled. Recurrence was defined as the reappearance of urothelial carcinoma. Progression was defined as stage/grade advance, metastasis, or cancer-related death. The primary outcomes were recurrence-free survival (RFS) and progression-free survival (PFS), and the secondary outcome was AE.

Results:

A total of 76 and 84 patients receiving Tice and Connaught, respectively were enrolled. The median follow-up periods for the Tice and Connaught groups were 32.0 months (range, 7-69 months) and 81.5 months (range, 9-154 months), respectively. Kaplan–Meier method showed no intergroup difference with regard to 3-year RFS and PFS. On Cox multivariate regression analysis, Tice was a significant predictor for inferior PFS (HR = 5.30; 95% CI, 1.11-25.29; p = 0.036). The AE incidence was 38.3% in the Connaught group and 25.0% in the Tice group (p = 0.079).

Conclusion:

Tice and Connaught were comparable in terms of RFS, PFS, and AE for patients with NMIBC accepting BCG induction and at least one maintenance course in our real-world practice. However, Tice was a predictor of inferior PFS on multivariate analysis.
Suppression of vacuolar-type ATPase and induction of endoplasmic reticulum stress by proton pump inhibitors
Authors: Lee Wei-Ping
Published: September 2022

Background:

Proton pump inhibitors (PPIs), such as esomeprazole, pantoprazole, dexlansoprazole, and rabeprazole, are one of the most commonly prescribed medications. Several studies have linked the long-term use of PPIs to a potentially increased risk of gastric cancer. Therefore, this study aimed to determine the underlying mechanism of PPI-mediated gastric cancer.

Methods:

Lysosomes were isolated using immunoprecipitation. The inhibition of vacuolar-type ATPase (V-ATPase) by PPIs was assayed using a PiColorLock Gold Phosphate Detection System. PPI-induced lysosomal stress was analyzed using transcription factor EB (TFEB) nuclear translocation. PPI-induced endoplasmic reticulum (ER) stress was analyzed using the expression of protein kinase RNA-like endoplasmic reticulum kinase (PERK), inositol-requiring enzyme 1 (IRE1), and activating transcription factor 6 (ATF6). Finally, reactive oxygen species (ROS) removal was determined using the activity of superoxide dismutase (SOD).

Results:

PPIs caused a 70% inhibition of V-ATPase activity at 20 μM, leading to lysosomal stress through TFEB nuclear translocation; ER stress by inducing the expression of PERK, IRE1, and ATF6; and enhanced SOD activity for ROS removal.

Conclusion:

The long-term use of PPIs inhibits lysosomal V-ATPase, leading to ER stress and ROS accumulation, which may result in an increased risk of gastric cancer. Because lysosomes and the ER are common organelles in cells, physicians prescribing PPIs for gastroesophageal reflux and peptic ulcer diseases should pay more attention to the general effects of these agents on the human body.
Mucosal color changes on narrow-band imaging in esophageal eosinophilic infiltration
Authors: Suda Tsuyoshi , Shirota Yukihiro , Hodo Yuji , Sato Katsuaki , Wakabayashi Tokio
Published: September 2022

This study aimed to examine the range of beige colored mucosa (BCM) in patients with esophageal eosinophilic infiltration (EEI) using narrow-band imaging (NBI).

In this retrospective study, EEI was confirmed histologically in 12 consecutive patients from January 2014 to December 2017. The BCM tone on NBI without magnifying endoscopy was evaluated, and red, green, and blue (RGB) values of BCM and normal mucosa were measured. BCM was macroscopically classified into 2 groups (bright and dark) using cluster analysis. Histopathological analysis was performed in 1 patient who underwent biopsy for both normal mucosa and BCM.

All 12 patients presented with BCM. Endoscopy revealed fixed rings, longitudinal furrows, mucosal edema, and exudate in 3, 12, 10, and 8 patients, respectively. Strictures were absent. Five patients had findings suggestive of gastroesophageal reflux disease. In the cluster analysis, 5 and 7 patients had bright and dark BCM, respectively. Consistent results were noted when we categorized patients according to their macroscopic characteristics. RGB values of the BCM and normal mucosa were measured—normal mucosa: R: 99.8 ± 16.5, G: 121.7 ± 23.1, and B: 93.4 ± 19.2; BCM: R: 152.0 ± 31.3, G: 123.9 ± 35.0, and B: 97.5 ± 29.5. BCM had significantly higher R values than normal mucosa (P = .0001). All parameters were significantly lower in the dark BCM group than in the bright BCM group (P < .001). Histopathological analysis revealed expansion of the epithelial intercellular space, eosinophilic infiltration, and basal cell hyperplasia at the BCM sites.

BCM was observed in all cases of EEI. RGB values differed between bright and dark BCM. Assessing BCM tone using NBI is a potentially novel diagnostic method for EEI.
Humidified versus nonhumidified low-flow oxygen therapy in children with Pierre-Robin syndrome: A randomized controlled trial
Authors: Zhang Xin , Fan Aijuan , Liu Yingfei , Wei Li
Published: September 2022

Background:

Humidification is an important process in clinical oxygen therapy. We aimed to evaluate the effects and safety of humidified versus nonhumidified low-flow oxygen therapy in children with Pierre-Robin syndrome.

Methods:

This study was an open-label, single-centered randomized controlled trial (RCT) with a parallel group design. The study protocol has been registered in Chinese Clinical Trial Registry (ChiCTR1900021584). The children were randomized to the humidified versus nonhumidified groups. Average arterial oxygen partial pressure (PaO2) and carbon dioxide partial pressure (PaCO2), incidence of ventilator-associated pneumonia (VAP), nasal cavity dryness, nasal mucosal bleeding and bacterial contamination of the humidified bottle, the cost of nasal oxygen therapy and duration of intensive care unit (ICU) stay were analyzed.

Results:

A total of 213 children with Pierre-Robin syndrome were included. There were no significant differences in the gender, age, weight, prematurity, duration of anesthesia and surgery duration of mandibular traction between humidified group and nonhumidified group (all P > .05). No significant differences in the average arterial PaO2 and PaCO2 level on the postoperative day 1, 2, and ICU discharge between humidified group and nonhumidified group were found (all P > .05). There were no significant differences in the incidence of nasal cavity dryness, nasal mucosal bleeding, bacterial contamination and VAP, the duration of ICU stay between humidified group and nonhumidified group (all P > .05). The cost of nasal oxygen therapy in the humidified group was significantly less than that of nonhumidified group (P = .013).

Conclusions:

Humidifying the oxygen with cold sterile water in the low-flow oxygen therapy in children may be not necessary. Future RCTs with lager sample size and rigorous design are warranted to further elucidate the effects and safety of humidified versus nonhumidified low-flow oxygen therapy.
Predictors associated with prefrailty in older Taiwanese individuals with type 2 diabetes
Authors: Lee Shu-Fen , Li Chih-Ping , Chen Yen-Lin , Pei Dee
Published: September 2022

Type 2 diabetes (T2DM) is one of the most well-studied and important factors that increase the risk of prefrailty in older people in Taiwan. This study was conducted to examine whether metabolic biomarkers, lifestyle behaviors, body composition, and chronic diseases are associated with frailty in older people with T2DM. We also observed how people manage their T2DM related to prefrailty. This study investigated a total of 201 participants diagnosed with T2DM who received care in our hospital from September 2018 to February 2019. Patients were divided into 3 groups (not frail, prefrail, and frail), and frailty was measured with the 5-item FRAIL scale. Socioeconomic characteristics, metabolic biomarkers, lifestyle behaviors, body composition, and chronic diseases were assessed at enrollment. No participants who we tested met the criteria for frailty. Based on the results of chi-square tests, prefrailty was associated with female sex, middle school education, unemployment, alcohol use, high body fat percentage, above-normal waist circumference, obesity, cardiovascular disease, and hypertension. Logistic regression analyses identified a significant correlation of prefrailty with the type of job from which they retired, cardiovascular disease, and hypertension. An important and surprising finding of this study was that the unemployed group was at high risk for prefrailty, which was not observed in previous research. The groups engaged in manual and professional jobs had better hand grip strength, a slower walking speed, and less risk of prefrailty than the unemployed group.
Prognostic factors of 30-day mortality in patients with COVID-19 pneumonia under standard remdesivir and dexamethasone treatment
Authors: Choi Yu Jung , Song Joon Young , Hyun Hakjun , Nham Eliel , Yoon Jin Gu , Seong Hye , Noh Ji Yun , Cheong Hee Jin , Kim Woo Joo
Published: September 2022

Although some studies have reported prognostic factors for coronavirus disease 2019 (COVID-19), they were conducted before standard treatment with remdesivir and dexamethasone was implemented. This retrospective, observational study was conducted to evaluate various prognostic factors in patients with COVID-19 pneumonia receiving standard treatment with remdesivir and dexamethasone. Of 99 patients with COVID-19 pneumonia, 68 (68.7%) died within 30 days of hospitalization. The mean age was 71.3 years. Remdesivir and dexamethasone were administered to 80 (80.8%) and 84 (84.8%) patients, respectively. Early antibiotic treatment was administered to 70 patients (70.7%) within 5 days of hospitalization. Dexamethasone (79.4% vs 96.8%, P = .033) was more frequently administered in the survived group, whereas early antibiotics (60.3% vs 93.5%, P = .001) were less frequently administered. In the multivariate analysis, a high National Early Warning Score (NEWS; odds ratio [OR] 1.272), high Charlson Comorbidity Index (CCI; OR 1.441), and dyspnea (OR 4.033) were independent risk factors for 30-day mortality. There was no significant difference in age, sex, and vaccination doses between the survived and fatal groups. Lymphopenia, monocytopenia and high levels of C-reactive protein (CRP)/lactate dehydrogenase (LDH) reflected poor prognosis. NEWS, CCI, and dyspnea were predictors of 30-day mortality in patients with COVID-19 pneumonia. Early antibiotic use did not lower the 30-day mortality risk.
Evaluation of post-infectious inflammatory reactions in a retrospective study of 3 common invasive bacterial infections in pediatrics
Authors: Abraham Pauline , Marin Gregory , Filleron Anne , Michon Anne-Laure , Marchandin Hélène , Godreuil Sylvain , Rodière Michel , Sarrabay Guillaume , Touitou Isabelle , Meslin Pauline , Tournier Carine , Van de Perre Philippe , Nagot Nicolas , Jeziorski Eric
Published: September 2022

Infectious diseases can result in unanticipated post-infectious inflammatory reactions (PIIR). Our aim was to explore PIIR in 3 frequent pediatric bacterial invasive infections in France by a retrospective monocentric study. We included children hospitalized between 2003 and 2012 for Streptococcus pneumoniae (SP), Neisseria meningitidis (NM), or Streptococcus pyogenes invasive infections. The PIIR had to have occurred between 3 and 15 days without fever despite an individually tailored antibiotic therapy. A descriptive analysis was carried out to determine PIIR risk factors. We included 189 patients, of whom 72, 79, and 38 exhibited invasive infections caused by S pyogenes, SP, and NM, respectively. The mean age was 44 months. PIIR were observed in 39 cases, occurring after a median of 8 days (5–12), with a median duration of 3 days (2–6). Fever, arthritis, and pleural effusion were observed in 87%, 28.2%, and 25.6%, respectively. In multivariate analysis, PIIR were associated with pleuropneumonia, hospitalization in an intensive care unit (ICU), and elevated C-reactive protein (CRP). PIIR were observed in 20% of children after SP, NM, or S pyogenes invasives infections. Their occurrence was associated with the initial severity but not the etiological microorganism. Further studies are warranted to confirm these findings.