bluuebunny/crossref_metadata_2025 huggingface dataset:
Anatomic maps of erogenous sensation and pleasure in the penis: are there difference between circumcised and uncircumcised men?
Authors: Zaliznyak Michael , Isaacson Dylan , Duralde Erin , Gaither Thomas W , Naser-Tavakolian Aurash , Bresee Catherine , Stelmar Jenna , Yuan Nance , Topp Kimberly , Garcia Maurice M
Published: January 2023

Background

The effects of male circumcision on sexual function remain controversial. Heterogeneity across previous studies and low-quality scientific evidence have resulted in poor understanding of the effects of circumcision on erogenous sensation of the penis and orgasm function.

Aim

In this study we sought to describe and assess differences in erogenous genital sensation and reported orgasm function in circumcised compared with uncircumcised men.

Methods

Adult male subjects who were recruited on a paid anonymous online survey platform were shown illustrations of 12 anatomic regions of the penis. Subjects were prompted to designate regions as pleasurable when touched during partnered sex and to rate each on a 1-10 scale, with higher erogeneity scores correlating with greater pleasure. Subjects were also asked to characterize their orgasms across 6 experiential domains.

Outcomes

Outcomes were differences between circumcised and uncircumcised men in the probabilities that regions would be designated as pleasurable, average pleasure scores, and self-reported orgasm parameters.

Results

In total, 227 circumcised (mean [SD] age 46.6 [17.7] years) and 175 uncircumcised men (47.8 [18.1] years) completed the survey. There were no significant differences in average ratings across all regions between circumcised and uncircumcised men. However, significantly more circumcised men reported preferences for the tip of the penis (38% vs 17%, P = .02) and the middle third of the ventral penile shaft (63% vs 48%, P = .04). Additionally, there were no significant differences in orgasm quality and function across all queried domains between circumcised and uncircumcised cohorts.

Clinical implications

Our findings suggest that circumcision does not change how men describe erogenous genital sensation or how they experience orgasm.

Strengths and limitations

In this study we expanded upon existing literature regarding comparison of sexual function in circumcised and uncircumcised men in its scale and investigation of diverse domains. Limitations include the survey format of data collection.

Conclusion

We found no differences in reported erogenous ratings or orgasm function between circumcised and uncircumcised men. These findings suggest that male circumcision does not negatively impact penile erogeneity or orgasm function.
The critical role of nuclear heating rates, thermalization efficiencies, and opacities for kilonova modelling and parameter inference
Authors: Bulla Mattia
Published: January 2023

We present an improved version of the 3D Monte Carlo radiative transfer code possis to model kilonovae from neutron star mergers, wherein nuclear heating rates, thermalization efficiencies, and wavelength-dependent opacities depend on local properties of the ejecta and time. Using an axially symmetric two-component ejecta model, we explore how simplistic assumptions on heating rates, thermalization efficiencies, and opacities often found in the literature affect kilonova spectra and light curves. Specifically, we compute five models: one (FIDUCIAL) with an appropriate treatment of these three quantities, one (SIMPLE-HEAT) with uniform heating rates throughout the ejecta, one (SIMPLE-THERM) with a constant and uniform thermalization efficiency, one (SIMPLE-OPAC) with grey opacities, and one (SIMPLE-ALL) with all these three simplistic assumptions combined. We find that deviations from the FIDUCIAL model are of several (∼1–10) magnitudes and are generally larger for the SIMPLE-OPAC and SIMPLE-ALL compared to the SIMPLE-THERM and SIMPLE-HEAT models. The discrepancies generally increase from a face-on to an edge-on view of the system, from early to late epochs and from infrared to ultraviolet/optical wavelengths. This work indicates that kilonova studies using either of these simplistic assumptions ought to be treated with caution and that appropriate systematic uncertainties ought to be added to kilonova light curves when performing inference on ejecta parameters.
Rheumatoid meningitis in a patient with overlap syndrome: The usefulness of anti-citrullinated peptide antibodies determination in CSF
Authors: Lorenzo-Barreto Pablo , Roy-Ariño Garbiñe , Pérez-Trapote Fernando , Sáez-Marín Alberto , Stiauren-Fernández Erik S , Zarza-Sanz Beatriz , García Barragán Nuria , de la Puente-Bujidos Carlos , Buisán-Catevilla F Javier
Published: January 2023

Rheumatoid meningitis (RM) is a rare complication of rheumatoid arthritis that can manifest as stroke-like episodes. We present the case of a 63-year-old woman with a past history of overlap syndrome and clinical manifestations suggestive of amyopathic dermatomyositis, rheumatoid arthritis, and systemic lupus erythematosus. She presented to the emergency department with sudden onset right-sided clumsiness and numbness, as well as a 2-week history of left hemicranial headache. Laboratory workup revealed positive serum antinuclear antibodies, anti-Ro antibodies, anti-citrullinated peptide antibodies (ACPA), and elevated rheumatoid factor. Lymphocytic pleocytosis, positive ACPA and anti-Ro antibodies with passive diffusion pattern, and negative microbiological studies were demonstrated in the CSF. Brain magnetic resonance imaging showed predominant left fronto-parieto-occipital leptomeningeal and pachimeningeal enhancement. She was diagnosed with RM and received methylprednisolone IV mg/kg once daily. Stroke-like episodes in the setting of a patient with lymphocytic pleocytosis in the cerebrospinal fluid (CSF) and meningeal enhancement should raise suspicion of RM. In this context, serum rheumatoid factor and ACPA levels should always be measured and ACPA should also be measured in CSF. To our knowledge, this is the first reported case of RM in the context of an overlap syndrome. ACPA levels in CSF could be a relevant diagnostic clue in the setting of central nervous system disturbance and overlapping autoimmune conditions that include rheumatoid arthritis. In our case, the presence of a suggestive clinical scenario of RM reinforces the probable pathogenic role of ACPA when it is present in the central nervous system, even without intrathecal synthesis evidence.
Salt stress-induced chloroplastic hydrogen peroxide stimulates pdTPI sulfenylation and methylglyoxal accumulation
Authors: Fu Zheng-Wei , Feng Yu-Rui , Gao Xiang , Ding Feng , Li Jian-Hui , Yuan Ting-Ting , Lu Ying-Tang
Published: January 2023

High salinity, an adverse environmental factor affecting about 20% of irrigated arable land worldwide, inhibits plant growth and development by causing oxidative stress, damaging cellular components, and disturbing global metabolism. However, whether and how reactive oxygen species disturb the metabolism of salt-stressed plants remain elusive. Here, we report that salt-induced hydrogen peroxide (H2O2) inhibits the activity of plastid triose phosphate isomerase (pdTPI) to promote methylglyoxal (MG) accumulation and stimulates the sulfenylation of pdTPI at cysteine 74. We also show that MG is a key factor limiting the plant growth, as a decrease in MG levels completely rescued the stunted growth and repressed salt stress tolerance of the pdtpi mutant. Furthermore, targeting CATALASE 2 into chloroplasts to prevent salt-induced overaccumulation of H2O2 conferred salt stress tolerance, revealing a role for chloroplastic H2O2 in salt-caused plant damage. In addition, we demonstrate that the H2O2-mediated accumulation of MG in turn induces H2O2 production, thus forming a regulatory loop that further inhibits the pdTPI activity in salt-stressed plants. Our findings, therefore, illustrate how salt stress induces MG production to inhibit the plant growth.
sarabande: 3/4 point correlation functions with fast Fourier transforms
Authors: Sunseri James , Slepian Zachary , Portillo Stephen , Hou Jiamin , Kahraman Sule , Finkbeiner Douglas P
Published: January 2023

We present a new python package sarabande for measuring 3- and 4-point correlation functions (3/4 PCFs) in $\mathcal {O} (N_{\mathrm{g}}\log N_{\mathrm{g}})$ time using fast Fourier transforms (FFTs), with Ng being the number of grid points used for the FFT. sarabande can measure both projected and full 3-point correlation function and 4-point correlation function on gridded two- and three-dimensional data sets. The general technique is to generate suitable angular basis functions on an underlying grid, radially bin these to create kernels, and convolve these kernels with the original gridded data to obtain expansion coefficients about every point simultaneously. These coefficients are then combined to give us the 3/4 PCF as expanded in our basis. We apply sarabande to simulations of the interstellar medium to show the results and scaling of calculating both the full and projected 3/4 PCFs.
Connectome-based predictive modeling of trait forgiveness
Authors: Li Jingyu , Qiu Jiang , Li Haijiang
Published: January 2023

Forgiveness is a positive, prosocial manner of reacting to transgressions and is strongly associated with mental health and well-being. Despite recent studies exploring the neural mechanisms underlying forgiveness, a model capable of predicting trait forgiveness at the individual level has not been developed. Herein, we applied a machine-learning approach, connectome-based predictive modeling (CPM), with whole-brain resting-state functional connectivity (rsFC) to predict individual differences in trait forgiveness in a training set (dataset 1, N = 100, 35 men, 17–24 years). As a result, CPM successfully predicted individual trait forgiveness based on whole-brain rsFC, especially via the functional connectivity of the limbic, prefrontal and temporal areas, which are key contributors to the prediction model comprising regions previously implicated in forgiveness. These regions include the retrosplenial cortex, temporal pole, dorsolateral prefrontal cortex (PFC), dorsal anterior cingulate cortex, precuneus and dorsal posterior cingulate cortex. Importantly, this predictive model could be successfully generalized to an independent sample (dataset 2, N = 71, 17 men, 16–25 years). These findings highlight the important roles of the limbic system, PFC and temporal region in trait forgiveness prediction and represent the initial steps toward establishing an individualized prediction model of forgiveness.
Insomnia symptoms and postoperative healthcare utilization in veterans undergoing decompressive laminectomy for lumbar spinal stenosis
Authors: Tighe Caitlan A , Bachrach Rachel L , Perera Subashan , Weiner Debra K
Published: January 2023

Study Objectives

Lumbar spinal stenosis is an age-related spine condition that contributes to pain and disability. Decompressive laminectomy (DL) is regularly performed to alleviate symptoms. Insomnia symptoms are common among people living with chronic pain and may affect key DL outcomes, such as healthcare utilization. We examined associations of insomnia symptom severity with post-DL healthcare utilization in veterans with lumbar spinal stenosis.

Methods

Veterans (N = 200) with lumbar spinal stenosis undergoing DL were recruited into a prospective cohort study and self-reported insomnia symptom severity on the Insomnia Severity Index prior to DL. Post-DL, veterans reported on pain and non-pain-related monthly healthcare office visits, emergency room visits, hospitalizations, and mental health visits for 1 year. Incident rate ratios (IRRs) obtained via negative binomial regression evaluated associations of insomnia symptom severity with healthcare utilization rates.

Results

Approximately 51% of participants endorsed insomnia symptoms of at least mild severity. Participants who reported at least mild insomnia symptoms had more healthcare office visits (IRR = 1.23, p = .04), general mental health visits (IRR = 3.98, p < .0001), and pain-related mental health visits (IRR = 9.55, p = .01) than those without insomnia symptoms. Adjusting for covariates, rates of mental health visits, overall (IRR = 3.13, p = .001) and pain-related (IRR = 6.93, p = .02), remained statistically significantly higher.

Conclusions

Insomnia symptoms are associated with postoperative healthcare utilization lending support for future work to examine the value of assessing and intervening on insomnia symptoms prelaminectomy.
Shift patterns, physical exercise, and Type 2 diabetes mellitus (T2DM): a prospective cohort study in China
Authors: Song Lin , Shen Jiayang , Wang Jin , Zhang Yu , Zhou Ziqi , Sang Lingli , Zhu Lejia , Wang Yangmei , Zhang Dajun , Li Di , Xiao Jing , Lian Yulong
Published: January 2023

To examine the relationships between different shift patterns and Type 2 diabetes mellitus (T2DM) risk, and determine whether physical exercise reduced the incidence of T2DM in shift workers in the oil industry.

Baseline data were collected from participants in May 2013 who were then followed for 4 years in a prospective cohort study. The cohort initially consisted of 3,002 workers and ultimately included 2,827 people. Baseline and follow-up questionnaires were sent to participants every 2 years (in May 2015 and May 2017) to update medical and lifestyle information during the follow-up period. The risk of T2DM among two shift workers [relative risk (RR) = 3.442, 95% CI: 1.904–6.799)], three shift workers (RR = 2.534, 95% CI: 1.484–4.571), and four shift workers (RR = 4.230, 95% CI: 2.680–7.518) was higher than that among day workers. An increasing trend was observed with respect to T2DM risk, with the lowest risk in three shift workers, moderate risk in two shift workers, and highest risk in four shift workers. In the interactive analysis between shift work and physical exercise, taking part in mild physical exercise increased the risk of T2DM for workers. Four shift workers who took part in mild physical exercise had an increased risk of T2DM. The relative excess risk due to interaction (RERI) was 33.769 (0.398–67.140). The attributable proportion due to interaction [API (%)] was 0.704 (0.529–0.880). The synergy index (SI) was 3.563 (1.900–6.683). Shift work is significantly correlated with increased incidence of T2DM. Risk of T2DM is lowest risk in three shift workers, moderate in two shift workers, and highest in four shift workers. Shift workers who participated in moderate and severe physical exercise had reduced risk of developing T2DM.
Exercise prescription, intervention, dissemination, and implementation following transient ischemic attack or stroke: advancing the field through interdisciplinary science
Authors: Bartsch Bria , Faulkner James , Moore Justin B , Stoner Lee
Published: January 2023

Lay Summary

Research has demonstrated that both exercise, and a reduction in cardiovascular disease (CVD) risk factors (i.e., high blood sugar, blood lipids, and blood pressure), following a stroke or transient ischemic attack (TIA) are beneficial for reducing risk of recurrent stroke or TIA and for improving overall quality of life. Despite this evidence, many stroke and TIA survivors remain inactive and sedentary and present with multiple CVD risk factors. The purpose of this commentary is to highlight gaps in the current literature in regard to exercise and behavior interventions for the stroke and TIA populations, present ideas for intervention design, and discuss the dissemination and implementation of research findings. The future research ideas presented in this commentary are based on current research findings, as well as the professional experience of the article authors. Professional experience spans occupational therapy in neurorehabilitation, clinical exercise physiology in rehabilitation, creation and implementation of stroke rehabilitation clinics, stroke and TIA research, and behavioral and implementation science.
Reactions to hypothetical flavor bans among current users of flavored e-cigarettes
Authors: Yang Yong , Lindblom Eric N , Ward Kenneth D , Salloum Ramzi G
Published: January 2023

Banning flavors in e-cigarettes and other tobacco products may decrease their use. To examine how current users of flavored e-cigarettes might react to a ban on flavored e-cigarettes when: (i) menthol flavor is banned together with other flavors, or (ii) this ban on e-cigarettes is combined with a ban on menthol cigarettes and flavored cigars. A national cross-sectional survey of 2,347 current users of flavored e-cigarettes was conducted in May 2022. For each hypothetical ban scenario, respondents reported if they would quit all tobacco product use, continue to use e-cigarettes with no flavor or flavors that were not banned, or switch to alternative tobacco products. Multinomial logistic regressions were used to estimate the associations between responses and ban scenarios, adjusting for tobacco use and demographic variables.

If e-cigarettes with any flavors except menthol and tobacco were banned, the majority of current e-cigarette users would keep using e-cigarettes with no flavor or tobacco and menthol flavor. When menthol flavor was added to a ban, a greater proportion of respondents would quit all tobacco use; however, more would also switch to cigarettes or cigars. When menthol cigarettes and flavored cigars were added to a ban, those who used menthol flavor only would be less likely to switch to cigarettes and cigars.

Among current e-cigarette users, the harm reduction (i.e., from quitting all use) from a ban on flavored e-cigarettes, particularly if menthol is also banned, may be outweighed by the harm increases (i.e., switching to cigarettes or cigars, or other products that are more harmful than using e-cigarettes). A concurrent ban on menthol cigarettes and flavored cigars would secure more certain net reductions to public health harms from e-cigarette use and smoking.
Application of the consolidated framework for implementation research to understand implementation context of a cardiovascular disease risk-reduction intervention in rural churches
Authors: Zimmermann Kristine , Muramatsu Naoko , Molina Yamilé , Carnahan Leslie R , Geller Stacie E
Published: January 2023

Rural populations in the USA face higher rates of cardiovascular disease (CVD) incidence and mortality relative to non-rural and often lack access to health-promoting evidence-based interventions (EBIs) to support CVD prevention and management. Partnerships with faith organizations offer promise for translating preventative EBIs in rural communities; however, studies demonstrating effective translation of EBIs in these settings are limited.

We used the Consolidated Framework for Implementation Research (CFIR) and a multiple case study approach to understand the role of internal organizational context within 12 rural churches in the implementation of a 12-week CVD risk-reduction intervention followed by a 24-month maintenance program implemented in southernmost Illinois.

The study involved qualitative analysis of key informant interviews collected before (n = 26) and after (n = 15) the intervention and monthly implementation reports (n = 238) from participating churches using a deductive analysis approach based on the CFIR.

Internal context across participating churches varied around organizational climate and culture in four thematic areas: (i) religious basis for health promotion, (ii) history of health activities within the church, (iii) perceived need for the intervention, and (iv) church leader engagement.

Faith organizations may be ideal partners in rural health promotion research but may vary in their interest and capacity to collaborate. Identifying contextual factors within community organizations is a first step to facilitating rural, community-based EBI implementation and outcomes.
Behavior change techniques in digital physical activity interventions for breast cancer survivors: a systematic review
Authors: Cooper Kellie B , Lapierre Stephanie , Carrera Seoane Montserrat , Lindstrom Katie , Pritschmann Ricarda , Donahue Marissa , Christou Demetra D , McVay Megan A , Jake-Schoffman Danielle E
Published: January 2023

Given the broad benefits of physical activity (PA) but low PA levels among breast cancer survivors (i.e., women who have received a breast cancer diagnosis), innovative and evidence-based techniques are needed to motivate and support exercise. This study systematically reviews the use of behavior change techniques (BCTs) in digital PA interventions for breast cancer survivors. Studies were retrieved from five electronic databases and were included if they (i) sampled exclusively female breast cancer survivors aged >18 years, (ii) involved a digital intervention with the primary purpose of increasing PA, (iii) included a BCT component, (iv) used a randomized or quasi-randomized design, and (v) were published from January 2000 to May 2022. Two coders independently extracted data. Twenty primary studies met the inclusion criteria and were included in this review. All interventions used at least one BCT (mean 4 ± 1, range 2–13); self-monitoring (85%) and goal setting (79%) were the most common BCTs. Twelve of 20 (60%) studies reported improvements in PA behavior in the intervention vs. control group, and self-monitoring and goal setting were the most commonly used BCTs in these studies. Of the 93 total BCTs, 66 were not used in any interventions in the review, including critical constructs for PA behavior change (e.g., biofeedback). BCTs, important facilitators of PA behavior change, are being underutilized in digital PA interventions for breast cancer survivors. Future research should incorporate more diverse BCTs to explore if they can add to the effectiveness of digital interventions for this population.
Factors influencing adults to drop out of intensive lifestyle interventions for weight loss
Authors: Ruelas Alma L , Martínez Contreras Teresita de Jesús , Esparza Romero Julián , Díaz Zavala Rolando Giovanni , Candia Plata Maria del Carmen , Hingle Melanie , Armenta Guirado Brianda , Haby Michelle M
Published: January 2023

Reducing ≥5% of body weight can decrease the risk of developing chronic diseases in adults with excess weight. Although Intensive Lifestyle Interventions (ILIs) that include cognitive-behavioral techniques to improve physical activity and eating habits are the best approach for losing weight, the failure to retain participants is a barrier to their successful implementation. We aimed to investigate the factors influencing adults to drop out of ILIs for weight loss at six months. We conducted retrospective multiple logistic regression analysis of 268 participants with excess weight (body mass index ≥ 25 kg/m2) from a multicenter study (n = 237, in-person ILI in five clinics, delivered by nutrition interns), and a randomized controlled trial (n = 31, one online ILI, delivered by a master’s degree student). The same research team conducted both studies in Northern Mexico, using the same intervention components, and identical instruments and techniques to collect the data. We found that older participants (≥50 years) were less likely to drop out of the ILI for weight loss compared to participants <35 years old (OR = 0.34, 95% CI = 0.16–0.70). For each unit increase in the bodily pain scale of the SF-36 (less perceived pain), the risk of dropping out decreased by 2% (OR = 0.98, 95% CI = 0.97, 0.996), while a change in the interventionist during the 6-month intervention more than doubled the risk of dropping out (OR 2.25, 95% CI = 1.23–4.14). Retention in ILIs may be improved by ensuring that the same interventionist remains during the six-month intervention. In addition, ILIs may need further tailoring for younger ages and for participants with higher perceived pain.
Snakes and ladders: A qualitative study understanding the active ingredients of social interaction around the use of audit and feedback
Authors: Desveaux Laura , Nguyen Marlena Dang , Ivers Noah Michael , Devotta Kimberly , Upshaw Tara , Ramji Noor , Weyman Karen , Kiran Tara
Published: January 2023

Explore characteristics of the facilitator, group, and interaction that influence whether a group discussion about data leads to the identification of a clearly specified action plan. Peer-facilitated group discussions among primary care physicians were carried out and recorded. A follow-up focus group was conducted with peer facilitators to explore which aspects of the discussion promoted action planning. Qualitative data was analyzed using an inductive-deductive thematic analysis approach using the conceptual model developed by Cooke et al. Group discussions were coded case-specifically and then analyzed to identify which themes influenced action planning as it relates to performance improvement. Physicians were more likely to interact with practice-level data and explore actions for performance improvement when the group facilitator focused the discussion on action planning. Only one of the three sites (Site C) converged on an action plan following the peer-facilitated group discussion. At Site A, physicians shared skepticism of the data, were defensive about performance, and explained performance as a product of factors beyond their control. Site B identified several potential actions but had trouble focusing on a single indicator or deciding between physician- and group-level actions. None of the groups discussed variation in physician-level performance indicators, or how physician actions might contribute to the reported outcomes. Peer facilitators can support data interpretation and practice change; however their success depends on their personal beliefs about the data and their ability to identify and leverage change cues that arise in conversation. Further research is needed to understand how to create a psychologically safe environment that welcomes open discussion of physician variation.
A scoping review of outer context constructs in dissemination and implementation science theories, models, and frameworks
Authors: Escoffery Cam , Sekar Swathi , Allen Caitlin G , Madrigal Lillian , Haardoerfer Regine , Mertens Ann
Published: January 2023

Many studies have explored organizational factors that facilitate implementation. However, there is still a limited understanding of determinants external to the implementing organization and their effects on evidence-based intervention (EBI) adoption, implementation, and outcomes. The purpose of this scoping review was to assess definitions of context and identify salient determinants of outer context found in dissemination and implementation theories, models, and frameworks. We employed a compilation of dissemination and implementation frameworks from two reviews as the data source. We abstracted the following information: type of article, outcomes of the framework, presence of a context definition, presence of any outer setting definition and the definition, number and domains of outer setting mentioned, definitions of outer context constructs, and any quantitative measures of outer setting. We identified 19 definitions of outer context. Forty-seven (49%) frameworks reported one or more specific constructs of the outer setting. While the outer context domains described in the frameworks varied, the most common domains were policy (n = 24), community (n = 20), partnerships (n = 13), and communications (n = 12). Based on our review of the frameworks, more conceptualization and measurement development for outer context domains are needed. Few measures were found and definitions of domains varied across frameworks. Expanding outer context construct definitions would advance measure development for important factors external to the organizations related to EBI implementation.
Constituent-driven health policy informed by policy advocacy literature
Authors: Figueroa Roger , Verma Rahul
Published: January 2023

In this position paper, a theoretical framework is proposed to formulate engaged, evidence-based health policy based on the priorities of constituents. An initial literature review was conducted to gain insight on the gaps in knowledge. Three emergent domains were identified: advocacy, research, and policymaking. The inputs and intermediates to the final output (equitable, evidence-based health policy outcomes) were identified and further elaborated upon in each corresponding section of the paper. Additionally, the main objective of each domain based on the literature review and the implications of each step were noted. Researchers have been identified as crucial to the education of policymakers to ultimately produce informed, evidence-based policy. Community advocates and researchers must attempt to advocate for policy issues as the ultimate role of policymakers in this process necessitates effective engagement to promote political will in the policymaking process. To do so, community advocates must scale-up from the individual to coalitions with strong leadership. In conjunction with a policy champion, these efforts by constituents (community advocates and researchers) would result in the most effective modes of policy development and implementation. The Constituent-driven Policy Advocacy Model (CPAM) introduced in this paper creates the potential for a new precedent in policymaking, in which advocacy, community engagement, evidence synthesis and evaluation, as well as science communication are common practices, leading to more sensitive, targeted, and equitable policy outcomes.
The Incidence of Thromboembolic Events During Hospitalizations Following Surgical Resection of Lower Extremity Sarcomas in Children: Utilizing the Pediatric Health Information System Database
Authors: Wright Joshua , Qamar Fatima , McLaughlin Mariel , Jodeh Diana S. , Amankwah Ernest , Mosha Maua , Halsey Jordan , Binitie Odion , Metts Jonathan , Goldenberg Neil , Rottgers S. Alex
Published: January 2023

Background:

Venous thromboembolism (VTE) is a frequent occurrence during treatment for adults with sarcoma. The incidence and underlying risk factors of postsurgical VTE in children and adolescents undergoing resection of sarcoma are unknown.

Methods:

Using International Classification of Disease revision-9 diagnostic and procedure codes, the Pediatric Health Information System database was queried for patients aged 18 years and younger, discharged from 2004 to 2015 with a diagnosis of lower extremity malignant neoplasm who had a tumor resection or amputation performed during the encounter. Malignant neoplasms of the pelvic bones and soft tissues were categorized as “pelvis tumors”, whereas malignant neoplasms of bone and soft tissues of the lower limbs were categorized as “lower limb tumors”. Hospitalizations were evaluated for the occurrence of VTE. Demographic characteristics (age at admission, sex, race, and race/ethnicity) and incidence of VTE were reported.

Results:

There were 2400 patients identified. Of these, 19 experienced VTE (0.79%) during their surgical hospitalization encounter. By anatomic group, the rate of VTE was 1.4% (CI: 0.5%-3.2%) for tumors in the pelvis and 0.6% (CI: 0.3%-1.0%) in lower limb tumors. Categorizing by age, the incidence of VTE was 1.2% in patients aged zero to 5, 0.3% in patients 6 to 13, and 1.2% in patients 14 to 18 years old. (Table 1). The extremely low rate of VTE occurrence precluded further analysis of risk factors.

Conclusions:

In this analysis, postsurgical VTE during hospitalization after pelvic and lower extremity sarcoma resection was an uncommon event in children and adolescents. There seemed to be an increased incidence of postsurgical VTE in pelvic tumors when compared with lower limb tumors, however, the rarity of all events precluded formal statistical analysis. A more robust data set would be required to determine if there are subsets of children and adolescents with sarcoma at higher risk of VTE that could benefit from thromboprophylaxis in the postoperative setting.

Level of Evidence:

Level II.
An Investigation of Body Size Impact on Organ Doses for Neutron External Exposures Using the MRCP-based Phantom Library
Authors: Han Haegin , Choi Ji Won , Lee Yumi , Lee Soo Min , Kim Chan Hyeong , Choi Hyun Joon , Yeom Yeon Soo
Published: January 2023

In a recent study, a comprehensive library composed of 212 phantoms with different body sizes was established by deforming the adult male and female mesh-type reference computational phantoms (MRCPs) of ICRP Publication 145 and the next-generation ICRP reference phantoms over the current voxel-type reference phantoms of ICRP Publication 110. In this study, as an application of the MRCP-based phantom library, we investigated dosimetric impacts due to the different body sizes for neutron external exposures. A comprehensive dataset of organ/tissue dose coefficients (DCs) for idealized external neutron beams with four phantoms for each sex representatively selected from the phantom library were produced by performing Monte Carlo simulations using the Geant4 code. The body size-dependent DCs produced in this study were systematically analyzed, observing that the variation of the body weights overall played a more important role in organ/tissue dose calculations than the variation of the body heights. We also observed that the reference body-size DCs based on the MRCPs indeed significantly under- or overestimated the DCs produced using the phantoms, especially for those much heavier (male: 175 cm and 140 kg; female: 165 cm and 140 kg) than the reference body sizes (male: 176 cm and 73 kg; female: 163 cm and 60 kg) by up to 1.6 or 3.3 times, respectively. We believe that the use of the body size-dependent DCs, together with the reference body-size DCs, should be beneficial for more reliable organ/tissue dose estimates of individuals considering their body sizes rather than the most common conventional approach, i.e., the sole use of the reference body size DCs.
THE REPORTING QUALITY OF NONINFERIORITY TRIALS USING INTRAVITREAL VASCULAR ENDOTHELIAL GROWTH FACTOR INHIBITORS
Authors: Jia Huixun , Li Tong , Wan Hongli , Wu Zhenyu , Sun Xiaodong
Published: January 2023

Purpose:

Noninferiority trials (NIFTs) are widely used to study intravitreal vascular endothelial growth factor inhibitors for the treatment of ocular diseases. Thus, this trial design deserves greater attention. We aimed to comprehensively assess the methodological and reporting quality of NIFTs in the field of neovascular ocular diseases.

Methods:

We identified NIFTs using antivascular endothelial growth factor agents published before February 2020 from PubMed and Web of Science. Two independent authors extracted and double-checked predefined elements related to the quality of design and reporting. The characteristics and reporting of NIFTs were described with frequencies and percentages. We summarized important factors that were potentially biased the results of NIFTs and provided point-to-point recommendations.

Results:

In total, 34 studies involving 15,190 subjects and 51 pairs of noninferiority comparisons were identified. Areas of concern that could potentially affect the qualities of NIFTs included the absence of justification for the selection of noninferiority margins (61.8%), the use of unusually wide noninferiority margins (26.5%), the lack of outcome confirmation provided by the intention-to-treat and per-protocol analyses (64.7%), the presence of postrandomization exclusions >10% (52.9%), and not declaring the compensatory benefits (35.3%). Moreover, industry-sponsored NIFTs were more likely to draw positive results (P= 0.036).

Conclusion:

NIFTs of antivascular endothelial growth factor therapies commonly achieved noninferiority of the tested intervention. However, the methodologies and reporting limitations may affect the confidence of the results. Thus, more awareness must be created among investigators for better adherence to guidelines and recommendations while designing, conducting, and reporting on NIFTs.
MACULAR SENSITIVITY CHANGE AFTER COMPLEMENTARY LASER THERAPY AFTER RANIBIZUMAB INTRAVITREAL INJECTION IN BRANCH RETINAL VEIN OCCLUSION
Authors: Ojima Akira , Kato Yutaka , Tomita Ryutaro , Kasai Akihito , Sugano Yukinori , Sekiryu Tetsuju
Published: January 2023

Purpose:

We examined the effect of ranibizumab with or without laser photocoagulation on retinal sensitivity in eyes with branch retinal vein occlusion.

Methods:

Prospective randomized control study. Thirty patients with branch retinal vein occlusion received intravitreal injection of ranibizumab in a monthly pro re nata regimen. Fifteen patients received ranibizumab monotherapy alone (monotherapy group). The remaining 15 patients received rescue laser therapy at 3 or 9 months (combined group). The retinal sensitivity was measured at 32 points within central 8°, and the average of the main occlusion side among the 16 upper or 16 lower points was defined as the affected area sensitivity.

Results:

In comparing the monotherapy group and the combined group, the number of injections during the 12 months was 5.4 versus 4.9, the change in retinal thickness (µm) was −254 versus −197, the ETDRS letters of improvement was +18.3 versus +19.6, and the change in the affected area sensitivity (dB) was +7.1 versus +4.6. At 12 months, all these results were significantly improved compared with their respective baselines, but none of the differences between the two groups reached statistical significance.

Conclusion:

Retinal sensitivity at 12 months improved in both the monotherapy group and the combined group. The additional laser did not reduce the number of injections or further improve visual acuity nor did it affect retinal sensitivity.
Interventions to improve nutritional status for older patients with cancer – a holistic approach is needed
Authors: Liposits Gabor , Singhal Surbhi , Krok-Schoen Jessica L.
Published: January 2023

Purpose of review

Older adults with cancer frequently experience malnutrition and sarcopenia resulting in lower treatment efficacy, increased risk of toxicities and healthcare costs, lower quality of life and shorter survival. Improving nutritional status in this rapidly growing population is an urgent need globally. We reviewed randomized controlled trials from the last 18 months focusing on nutritional status and applying multimodal interventions in older adults with cancer.

Recent findings

Several randomized controlled trials have been reported recently elucidating the impact of nutritional interventions as a part of multimodal interventions through different stages of cancer care. Although multimodal interventions rarely demonstrate survival benefit, they improve several important aspects of cancer care, including patient-centred endpoints such as physical functioning, adherence, patient satisfaction and quality of life.

Multimodal interventions including nutrition have the potential to improve patient-centred outcomes in older adults with cancer during the continuum of care, from prehabilitation to palliative care. Early, integrated supportive care applying the right intervention in the right setting at the proper time along with personalized antitumor treatment is the cornerstone of optimal holistic cancer care.
Care needs of older patients with advanced cancer
Authors: Molassiotis Alex , Wang Mian
Published: January 2023

Purpose of review

This review summarized current research evidence examining care needs of older patients with advanced cancer in dealing with disease, treatment, and treatment-related side effects. It also identified gaps and directions for future research and practice.

Recent findings

Older patients with advanced cancer need support from health professionals, family, friends, and other social network members in the management of physical symptoms and functioning, psychosocial and spiritual care, information provision, and practical resolution of daily problems. As older patients are affected by aging-related factors, they usually have unique patterns of care needs compared with younger patients.

Currently, insufficient research evidence hinders a comprehensive understanding of care needs of older patients with advanced cancer, as well as potential influencing factors. Future efforts are needed to develop more sophisticated assessment methods and interventions to better understand and address care needs of older patients with advanced cancer.
Adding age-adjusted shock index to the American College of Surgeons' trauma team activation criteria to predict severe injury in children
Authors: McCormick Taylor , Haukoos Jason , Hopkins Emily , Trent Stacy , Adelgais Kathleen , Cohen Mitchell , Gausche-Hill Marianne
Published: January 2023

BACKGROUND

The American College of Surgeons (ACS) requires trauma centers to use six minimum criteria (ACS-6) for full trauma team activation. Our goal was to evaluate the effect of adding age-adjusted shock index (SI) to the ACS-6 for the prediction of severe injury among pediatric trauma patients with the hypothesis that SI would significantly improve sensitivity with an acceptable decrease in specificity.

METHODS

We performed a secondary analysis of prospectively collected EMS and trauma registry data from two urban pediatric trauma centers. Age-adjusted SI thresholds were calculated as heart rate divided by systolic blood pressure using 2020 Pediatric Advanced Life Support SI vital sign ranges and previously published Shock Index, Pediatric Adjusted (SIPA) thresholds. The primary outcome was a composite of emergency operative (within 1 hour of arrival) or emergency procedural intervention (EOPI) or Injury Severity Score (ISS) greater than 15. Sensitivities, specificities, and 95% CIs were calculated for the ACS-6 alone and in combination with age-adjusted SI.

RESULTS

There were 8,078 patients included; 20% had an elevated age-adjusted SI and 17% met at least one ACS minimum criterion; 1% underwent EOPI; and 17% had ISS >15. Sensitivity and specificity of the ACS-6 for EOPI or ISS > 5 were 45% (95% confidence interval [CI], 41–50%) and 89% (95% CI, 81–96%). Inclusion of Pediatric Advanced Life Support-SI and SIPA resulted in sensitivities of 51% (95% CI, 47–56%) and 69% (95% CI, 65–72%), and specificities of 80% (95% CI, 71–89%) and 60% (95% CI, 53–68%), respectively. Similar trends were seen for each secondary outcome.

CONCLUSION

In this cohort of pediatric trauma registry patients, the addition of SIPA to the ACS-6 for trauma team activation resulted in significantly increased sensitivity for EOPI or ISS greater than 15 but poor specificity. Future investigation should explore using age-adjusted shock index in a two-tiered trauma activation system, or in combination with novel triage criteria, in a population-based cohort.

LEVEL OF EVIDENCE

Diagnostic Tests or Criteria; Level II.
Bowel Preparation Prior to Non-Elective Sigmoidectomy for Sigmoid Volvulus: Highly Beneficial but Vastly Underused
Authors: Schudrowitz Natalie , Shahan C Patrick , Moss Tovah , Scarborough John E
Published: January 2023

Introduction:

Although strong evidence exists for combined mechanical and oral antibiotic bowel preparation prior to elective colorectal resection, the utility of preoperative bowel preparation for patients undergoing sigmoid resection after endoscopic decompression of sigmoid volvulus has not been previously examined. The goal of this study was to evaluate the association between bowel preparation and postoperative outcomes for patients undergoing semi-elective, same-admission sigmoid resection for acute volvulus.

Methods:

Patients from the 2012-2019 Colectomy-Targeted ACS NSQIP dataset who underwent sigmoid resection with primary anastomosis after admission for sigmoid volvulus were included. Multivariable logistic regression was used to compare the risk-adjusted 30-day postoperative outcomes of patients who received combined preoperative bowel prep with those of patients who received either partial (mechanical or oral antibiotic alone) or incomplete bowel preparation. Effort was made to exclude patients whose urgency of clinical condition at hospital admission precluded an attempt at preoperative decompression and subsequent bowel preparation.

Results:

2,429 patients were included, 322 (13.3%) of whom underwent complete bowel preparation and 2,107 (86.7%) of whom underwent partial or incomplete bowel preparation. Complete bowel preparation was protective against several postoperative complications (including anastomotic leak), mortality, and prolonged postoperative hospitalization.

Conclusions:

This study demonstrates a significant benefit for complete bowel preparation prior to semi-elective, same-admission sigmoid resection in patients with acute sigmoid volvulus. However, only a small percentage of patients in this national sample underwent complete preoperative bowel preparation. Broader adoption of bowel preparation may reduce overall rates of complication in patients who require sigmoid colectomy due to volvulus.
Epidemic Persistence: Equilibria and Stability Analysis of Spread Process Dynamics over Networks, with Asymptomatic Carriers and Heterogeneous Model Parameters
Authors: Bi Xiaoqi , Beck Carolyn L.
Published: January 2023

We present an analysis of epidemiological compartment models that explicitly capture the dynamics of asymptomatic but infectious individuals. Our models can be viewed as an extension to classic SIR models, to which a distinct Asymptomatic compartment is added. We discuss both a group compartment model capturing a Susceptible-Asymptomatic-Infected-Recovered-Susceptible (SAIRS) epidemic process, and also introduce and evaluate SAIRS dynamics evolving over networks. We investigate equilibria and stability properties that include both disease-free and endemic equilibria states for these models, providing sufficient conditions for convergence to these equilibria. Model parameter estimation results based on local test-site and Peoria county clinic data are given, and a number of simulations illustrating the effects of asymptomatic-infected individuals and network structure on the spread and/or persistence of the disease are presented.
A HicA toxin-based counter-selection marker for allelic exchange mutations in Fusobacterium nucleatum
Authors: Bibek GC , Zhou Peng , Wu Chenggang
Published: January 2023

The study of fusobacterial virulence factors has dramatically benefited from the creation of various genetic tools for DNA manipulation, including thegalK-basedcounterselection for in-frame deletion mutagenesis inFusobacterium nucleatumthat was recently developed. However, this method requires a host lacking thegalKgene, which is an inherent limitation. To circumvent this limitation, we explored the possibility of using thehicAgene that encodes a toxin consisting of a HicAB toxin-antitoxin module inFusobacterium periodonticumas a new counter-selective marker. Interestingly, the full-lengthhicAgene is not toxic inF. nucleatum, but a truncatedhicAgene version lacking the first six amino acids is functional as a toxin. The toxin expression is driven by anrpsJpromoter and is controlled at its translational level using a theophylline-responsive riboswitch unit. As a proof of concept, we created markerless in-frame deletions in the fusobacterial adhesin RadD gene within theF. nucleatum radoperon and thetnaAgene that encodes the tryptophanase for indole production. After vector integration, plasmid excision after counterselection appeared to have occurred in 100% of colonies grown on theophylline-added plates and resulted in in-frame deletions in 50% of the screened isolates. ThishicA-based counterselection system provides a robust and reliable counterselection in wild-type backgroundF. nucleatumand should also be adapted for use in other bacteria.

IMPORTANCE

Fusobacterium nucleatumis an indole-producing human oral anaerobe associated with periodontal diseases, preterm birth, and several cancers. Little is known about the mechanisms of fusobacterial pathogenesis and associated factors mainly due to the lack of robust genetic tools for this organism. Here we showed that a mutatedhicAgene fromFuosbacterium periodonticumexpresses an active toxin and was used as a counterselection marker. ThishicA-based in-frame deletion system efficiently creates in-frame deletion mutations in the wild-type background ofF. nucleatum. This is the first report to use thehicAgene as a counterselection marker in a bacterial genetic study.