bluuebunny/crossref_metadata_2025 huggingface dataset:
A (NOT SO) RARE CASE OF ACS IN A YOUNG WOMAN
Authors: Loffreno A , De Carlini C , Bersano C , Saltafossi D , Chiappa L , Rogacka R , Aurino L , Spinelli M , Ajello S , Scandroglio M , Calvo F , Achilli F
Published: May 2024

A 39 yo Caucasian woman, former smoker, with a previous history of gestational hypertension requiring therapy for several months, presented to the ED with persistent oppressive chest pain. No prior ischemic, constitutional or inflammatory symptoms emerged. Physical examination revealed a left carotid bruit and a continuous murmur at the base, Killip I. The ECG showed negative T waves in the inferior leads, the echo “point of care” normal systolic function, akinesia of the inferior wall, moderate aortic insufficiency, normal dimensions of the ascending aorta. HS T troponin rose to 188 ng/L and NT–proBNP 1621 pg/mL, CPR was normal. Coronary angiography revealed a tight subocclusive stenosis of the proximal right coronary artery trated by angioplasty with drug–eluting stent placement. In the ICU diminished pedal pulses were noticed, along with a significant discrepancy in blood pressure values between the four limbs (right upper 150/60 mmHg, left 140/60 mmHg, lower right 70/40 mmHg, left 60/40 mmHg). The echocardiogram showed normalized LV kinesis, moderate aortic insufficiency, normal dimensions of the ascending aorta and arch, flow acceleration at the isthmus (Vmax 4.6 m/s, Gmax 86 mmHg). CT angiography revealed thickening of the walls of the epiaortic vessels (with a non critical stenosis of the left carotid), of the thoracic and the abdominal aorta with complete occlusion of the subrenal segment and the inferior mesenteric artery (reconstituted by the Riolano artery and distal rectal arteries); the distal iliac arteries at the carrefour were separately reconstituted. 18F–FDG PET/CT confirmed diffuse hypercaptation along the ascending aorta, isthmus and proximal descending portion indicative of active vasculitis. Elevation of ESR 110 mm/h and CRP 21 mg/L was observed. The diagnosis of Takayasu‘s arteritis (TA) was estabilished and treatment with prednisone and methotrexate was started, resulting in the normalization of acute phase markers and clinical stability at 3 months. TA is a vasculitis that primarily involves the aorta and its main branches. The diagnosis can be challenging due to the heterogeneous clinical course and lack of specific laboratory markers. Diagnostic delay and persisting inflammation can lead to catastrophic consequences. Despite its rarity, TA can account for a notable proportion of young women with documented myocardial ischemia; hence, cardiologists must be sensitive to this pathology particularly in high–risk populations.
GENDER DIFFERENCES ON CLINICAL OUTCOMES IN PATIENTS UNDERGOING TRANSCATHETER PULMONARY VALVE IMPLANTATION
Authors: Marzullo R , Laudadio R , Solimene A , Giordano M , Gaio G , Cappelli Bigazzi M , Palladino T , Sarubbi B , Russo M
Published: May 2024

Background

The impact of gender on clinical outcomes after Transcatheter Pulmonary Valve Implantation (TPVI) in patients with Congenital Heart Diseases (CHDs) is not well investigated.

Objectives

This is a retrospective single center study including 54 consecutive patients with CHDs referred to TPVI between 2010 and 2023 in our cardiac catheterization laboratory. Differences in–hospital, short– and medium–term outcomes between male and female were examined.

Methods and Results

Women comprised 43% of the cohort. The mean age did not differ among the groups (female: 26 +14 yrs vs male: 27+14 yrs). No significant difference in the type of implanted valve was found according the gender (Melody Valve: 31% in females vs 40% in males, p= 0.92; Sapien 11% in females vs 16.6% in males, p= 0.85). Despite women had higher rates of peri–procedural complications (60% vs 40%, p–value =0.05), in hospital events were similar in both groups (45% in females vs 55% in males, p value =0.9). The only exitus occurred in a woman. Median medium–term follow–up was 4,1 years (range 1 months–12.2 years). Out of total 37 MACEs, 19 occured in males and 18 females, (p–value=0.18). There was no significant differences in the rate of endocarditis (33% in females vs 64% males; p–value = 0.53); re–hospitalization (48% females vs 52% in males, p–value = 0.36), arrhythmias (46% in females vs 54% in males, p–value =0.76) and re–intervention (56% females vs 44% males, p–value = 0.18) between women and men.

Conclusions

Women with CHDs undergoing TPVI present higher rate of peri– operative complications compared to men but showed comparable outcomes at medium term follow up .
TRANSCATHETER BICAVAL VALVES SYSTEM IMPLANTATION FOR SEVERE TRICUSPID REGURGITATION. IMPORTANCE OF THE LOAD
Authors: Serra W , Vignali L
Published: May 2024

The management of patients with severe symptomatic tricuspid regurgitation (TR) remains extremely challenging for Cardiac Heart Team. Studying the load on the right ventricle and the interaction between among the ventricle, valve and pulmonary artery could be the key to detecting such patients. . The systolic pulmonary artery pressure (sPAP)/ pulmonary artery acceleration time (PAAT) ratio could be used as an indicator a marker of pulmonary vascular load, to identify patients who could benefit from transcatheter tricuspid valve repair (TTVR). In this case report we describe a patients with severe tricuspid regurgitation and mild pre–capillary pulmonary hypertension. . sPAP/PAP ratio was 0.6. After extensive discussion inside of the ‘Parma Heart Team’,cardiac surgery was ruled out. Other percutaneous device were excluded for the dilatation of tricuspid annulus and the retraction of the flaps. The choice of the device was directed toward a bicaval device called ‘TricValve’. Device implantation:The two fully pre–mounted devices are implanted via femoral access with fluoroscopy and transesophageal echo guidance under monitored anesthesia care.At the ECO– CT control, the dimensions of the IVC were reduced (30mm from 41mm) while the hepatic vein backflow was absent . In this case device placement prevents regurgitant flow in the IVC and SVC, reduced liver congestion and right ventricle stroke volume into the pulmonary system and cardiac output was improved.The patient’s selection, the ventricular–arterial coupling and the type of device depending on the anatomic functional conditions are the challenges. sPAP/PAP ratio < 0.6 could be a good predictor of the success of the procedure,but will have to be validated in a larger study.
Defects in diffusion barrier function of ciliary transition zone caused by ciliopathy variations of TMEM218
Authors: Fujii Taiju , Liang Luxiaoxue , Nakayama Kazuhisa , Katoh Yohei
Published: May 2024

Primary cilia are antenna-like structures protruding from the surface of various eukaryotic cells, and have distinct protein compositions in their membranes. This distinct protein composition is maintained by the presence of the transition zone (TZ) at the ciliary base, which acts as a diffusion barrier between the ciliary and plasma membranes. Defects in cilia and the TZ are known to cause a group of disorders collectively called the ciliopathies, which demonstrate a broad spectrum of clinical features, such as perinatally lethal Meckel syndrome (MKS), relatively mild Joubert syndrome (JBTS), and nonsyndromic nephronophthisis (NPHP). Proteins constituting the TZ can be grouped into the MKS and NPHP modules. The MKS module is composed of several transmembrane proteins and three soluble proteins. TMEM218 was recently reported to be mutated in individuals diagnosed as MKS and JBTS. However, little is known about how TMEM218 mutations found in MKS and JBTS affect the functions of cilia. In this study, we found that ciliary membrane proteins were not localized to cilia in TMEM218-knockout cells, indicating impaired barrier function of the TZ. Furthermore, the exogenous expression of JBTS-associated TMEM218 variants but not MKS-associated variants in TMEM218-knockout cells restored the localization of ciliary membrane proteins. In particular, when expressed in TMEM218-knockout cells, the TMEM218(R115H) variant found in JBTS was able to restore the barrier function of cells, whereas the MKS variant TMEM218(R115C) could not. Thus, the severity of symptoms of MKS and JBTS individuals appears to correlate with the degree of their ciliary defects at the cellular level.
An endogenous retrovirus regulates tumor-specific expression of the immune transcriptional regulator SP140
Authors: Dziulko Adam K , Allen Holly , Chuong Edward B
Published: May 2024

Speckled Protein 140 (SP140) is a chromatin reader with critical roles regulating immune cell transcriptional programs, and SP140 splice variants are associated with immune diseases including Crohn’s disease, multiple sclerosis, and chronic lymphocytic leukemia. SP140 expression is currently thought to be restricted to immune cells. However, by analyzing human transcriptomic datasets from a wide range of normal and cancer cell types, we found recurrent cancer-specific expression of SP140, driven by an alternative intronic promoter derived from an intronic endogenous retrovirus (ERV). The ERV belongs to the primate-specific LTR8B family and is regulated by oncogenic mitogen-activated protein kinase (MAPK) signaling. The ERV drives expression of multiple cancer-specific isoforms, including a nearly full-length isoform that retains all the functional domains of the full-length canonical isoform and is also localized within the nucleus, consistent with a role in chromatin regulation. In a fibrosarcoma cell line, silencing the cancer-specific ERV promoter of SP140 resulted in increased sensitivity to interferon-mediated cytotoxicity and dysregulation of multiple genes. Our findings implicate aberrant ERV-mediated SP140 expression as a novel mechanism contributing to immune gene dysregulation in a wide range of cancer cells.
Postoperative quality of life and pain after upper hemisternotomy and conventional median sternotomy for aortic valve replacement: results of a randomized clinical trial
Authors: Klop Idserd D G , Van Putte Bart P , Kloppenburg Geoffrey T L , Klautz Robert J M , Sprangers Mirjam A G , Nieuwkerk Pythia T , Klein Patrick
Published: May 2024

OBJECTIVES

Surgical aortic valve replacement through conventional sternotomy yields excellent results. Minimally invasive techniques are deemed equally safe and serve as a viable and less traumatic alternative. However, it is unclear how both surgical techniques affect patient-reported outcomes. The objective of this trial is to compare postoperative cardiac-related quality of life and postoperative pain after upper hemisternotomy and conventional surgical aortic valve replacement.

METHODS

In this single-centre, open-label, investigator-initiated randomized clinical trial, patients were randomized to upper hemisternotomy or conventional full median sternotomy. Patients unable to undergo randomization were monitored prospectively (registry group). Primary outcome was cardiac-specific quality of life, measured with the Kansas City Cardiomyopathy Questionnaire up to 1 year postoperatively.

RESULTS

Patients undergoing upper hemisternotomy had a significantly higher physical limitation domain score across all postoperative time points than patients undergoing conventional surgical aortic valve replacement (estimated mean difference 2.12 points; P = 0.014). Patients undergoing upper hemisternotomy were more likely to have a pain score <30 the first 2 days postoperatively than patients undergoing conventional surgical aortic valve replacement (odds ratio 2.63; P = 0.007). This was associated with reduced opioid analgesic intake. Postoperative surgical outcome did not differ between both groups.

CONCLUSIONS

Surgical aortic valve replacement through both conventional sternotomy and upper hemisternotomy resulted in clinically similar and important improvements in quality of life, with a small advantage for upper hemisternotomy, while there was no compromise in safety.
Modeling the growth of Aspergillus brasiliensis affected by a nonthermal plasma
Authors: Zdeňková Kamila , Jirešová Jana , Lokajová Eliška , Klenivskyi Myron , Julák Jaroslav , Marin Marco Antonio Lopez , Tichá Petra , Domonkos Mária , Demo Pavel , Scholtz Vladimír
Published: May 2024

Aim

The main objective of the study was to develop and validate a model for the growth of Aspergillus brasiliensis on surfaces, specifically on agar culture medium. An additional aim was to determine conditions for complete growth inhibition of this micromycete using two different nonthermal plasma (NTP) sources.

Methods and results

The developed model uses two key parameters, namely the growth rate and growth delay, which depend on the cultivation temperature and the amount of inoculum. These parameters well describe the growth of A. brasiliensis and the effect of NTP on it. For complete fungus inactivation, a single 10-minute exposure to a diffuse coplanar surface barrier discharge was sufficient, while a point-to-ring corona discharge required several repeated 10-minute exposures at 24-h intervals.

Conclusions

The article presents a model for simulating the surface growth of A. brasiliensis and evaluates the effectiveness of two NTP sources in deactivating fungi on agar media.
Picturing the flora of China
Authors: Coulton Richard
Published: May 2024

This paper traces the provenance of some 2,400 plant paintings obtained by early British commercial travellers to Xiamen 廈門, long pre-dating the later ‘export trade’ in Chinese botanical art. Nine principal sets of paintings form five ‘assemblages’ across the British Library and Oak Spring Garden Foundation in Upperville, Virginia. Each painting, in one of two styles, depicts a single plant labelled with its Chinese name. The first style (‘boneless’) either deploys limited outlines to denote form or lacks outlines altogether, and incorporates resemblances to traditions of bencao 本草 (materia medica) illustration and huaniaohua 花鳥畫 (flower-and-bird) painting. The second uses prominent inked outlines and more firmly resembles bencao illustrations. Two merchants, James Cuninghame and Christopher Brewster, are identified as purchasers of some paintings, and their acquisitions entered the metropolitan collections of James Petiver and Sir Hans Sloane. A single Chinese actor, ‘Dr Bun-ko’, is named in an annotation on 309 ‘Bunko–Brewster Paintings’ which have newly been shown to encompass holdings at the British Library and Oak Spring.
CP factor model for dynamic tensors
Authors: Han Yuefeng , Yang Dan , Zhang Cun-Hui , Chen Rong
Published: May 2024

Observations in various applications are frequently represented as a time series of multidimensional arrays, called tensor time series, preserving the inherent multidimensional structure. In this paper, we present a factor model approach, in a form similar to tensor CANDECOMP/PARAFAC (CP) decomposition, to the analysis of high-dimensional dynamic tensor time series. As the loading vectors are uniquely defined but not necessarily orthogonal, it is significantly different from the existing tensor factor models based on Tucker-type tensor decomposition. The model structure allows for a set of uncorrelated one-dimensional latent dynamic factor processes, making it much more convenient to study the underlying dynamics of the time series. A new high-order projection estimator is proposed for such a factor model, utilizing the special structure and the idea of the higher order orthogonal iteration procedures commonly used in Tucker-type tensor factor model and general tensor CP decomposition procedures. Theoretical investigation provides statistical error bounds for the proposed methods, which shows the significant advantage of utilizing the special model structure. Simulation study is conducted to further demonstrate the finite sample properties of the estimators. Real data application is used to illustrate the model and its interpretations.
The Human Being as the Image of God
Authors: Greenberg Irving (Yitz)
Published: May 2024

This is a theological exposition of the biblical statement that the human being is created in the image of God (Genesis 1:26). The treatment concludes that this affirmation is the clal gadol, the foundational principle of the whole Torah (as Ben Azzai says, Talmud Yerushalmi, Nedarim, ch. 9, h. 4). There are four dimensions to the image of God: (1) Intrinsic dignities—that all human beings (no matter gender, skin color, race, religion) are endowed by their Creator with three intrinsic dignities: infinite value, equality, and uniqueness; (2) Capabilities—God has infinite consciousness, power, relationship (=love), freedom, and life. Humans have these capabilities in a finite but remarkable, i.e., Godlike, form. According to Rabbi Joseph B. Soloveitchik, humans fulfill the commandment of Imitatio Dei (v’halachta b’drachav) by developing these capabilities. God bestows these capabilities on humans to use in fulfilling a mission to perfect God’s Creation in partnership with the Divine (=covenant); (3) These dignities are rooted in love. That all humans possess these dignities reflects the fact that God loves all life, especially humans (the most advanced form of life); (4) Prophetic messianism envisions this planet turned into a Garden of Eden (paradise). This is a reality worthy of an image of God, i.e., the enemies of life (poverty, hunger, oppression, war, sickness) are overcome and the fullness of human dignity (infinite value, equality, uniqueness) is honored, in actual practice, in daily life.
Continuum emission from within the plunging region of black hole discs
Authors: Mummery Andrew , Ingram Adam , Davis Shane , Fabian Andrew
Published: May 2024

The thermal continuum emission observed from accreting black holes across X-ray bands has the potential to be leveraged as a powerful probe of the mass and spin of the central black hole. The vast majority of existing ‘continuum fitting’ models neglect emission sourced at and within the innermost stable circular orbit (ISCO) of the black hole. Numerical simulations, however, find non-zero emission sourced from these regions. In this work, we extend existing techniques by including the emission sourced from within the plunging region, utilizing new analytical models that reproduce the properties of numerical accretion simulations. We show that in general the neglected intra-ISCO emission produces a hot-and-small quasi-blackbody component, but can also produce a weak power-law tail for more extreme parameter regions. A similar hot-and-small blackbody component has been added in by hand in an ad hoc manner to previous analyses of X-ray binary spectra. We show that the X-ray spectrum of MAXI J1820+070 in a soft-state outburst is extremely well described by a full Kerr black hole disc, while conventional models that neglect intra-ISCO emission are unable to reproduce the data. We believe this represents the first robust detection of intra-ISCO emission in the literature, and allows additional constraints to be placed on the MAXI J1820 + 070 black hole spin which must be low a• < 0.5 to allow a detectable intra-ISCO region. Emission from within the ISCO is the dominant emission component in the MAXI J1820 + 070 spectrum between 6 and 10 keV, highlighting the necessity of including this region. Our continuum fitting model is made publicly available.
An evaluation of the BALROG and RoboBA algorithms for determining the position of Fermi/GBM GRBs
Authors: López K Ocelotl C , Watson Alan M , Lee William H , Becerra R L , Pereyra Margarita
Published: May 2024

The Fermi/GBM instrument is a vital source of detections of gamma-ray bursts and has an increasingly important role to play in understanding gravitational-wave transients. In both cases, its impact is increased by accurate positions with reliable uncertainties. We evaluate the RoboBA and BALROG algorithms for determining the position of gamma-ray bursts detected by the Fermi/GBM instrument. We construct a sample of 54 bursts with detections both by Swift/BAT and by Fermi/GBM. We then compare the positions predicted by RoboBA and BALROG with the positions measured by BAT, which we can assume to be the true position. We find that RoboBA and BALROG are similarly precise for bright bursts whose uncertainties are dominated by systematic errors, but RoboBA performs better for faint bursts whose uncertainties are dominated by statistical noise. We further find that the uncertainties in the positions predicted by RoboBA are consistent with the distribution of position errors, whereas BALROG seems to be underestimating the uncertainties by a factor of about 2. Additionally, we consider the implications of these results for the follow-up of the optical afterglows of Fermi/GBM bursts. In particular, for the DDOTI wide-field imager we conclude that a single pointing is best. Our sample would allow a similar study to be carried out for other telescopes.
Fast emulation of two-point angular statistics for photometric galaxy surveys
Authors: Bonici Marco , Biggio Luca , Carbone Carmelita , Guzzo Luigi
Published: May 2024

We develop a set of machine-learning-based cosmological emulators, to obtain fast model predictions for the C(ℓ) angular power spectrum coefficients, characterizing tomographic observations of galaxy clustering and weak gravitational lensing from multiband photometric surveys (and their cross-correlation). A set of neural networks are trained to map cosmological parameters into the coefficients, achieving, with respect to standard Boltzmann solvers, a speed-up of $\mathcal {O}(10^3)$ in computing the required statistics for a given set of cosmological parameters, with an accuracy better than 0.175  per cent (<0.1  per cent for the weak lensing case). This corresponds to $\lesssim 2~{{\ \rm per\ cent}}$ of the statistical error bars expected from a typical Stage IV photometric surveys. Such overall improvement in speed and accuracy is obtained through (i) a specific pre-processing optimization, ahead of the training phase, and (ii) an effective neural network architecture. Compared to previous implementations in the literature, we achieve an improvement of a factor of 5 in terms of accuracy, while training a considerably lower amount of neural networks. This results in a cheaper training procedure and a higher computational performance. Finally, we show that our emulators can recover unbiased posteriors when analysing synthetic Stage-IV galaxy survey data sets.
Annotation and visualization of parasite, fungi and arthropod genomes with Companion
Authors: Haese-Hill William , Crouch Kathryn , Otto Thomas D
Published: May 2024

As sequencing genomes has become increasingly popular, the need for annotation of the resulting assemblies is growing. Structural and functional annotation is still challenging as it includes finding the correct gene sequences, annotating other elements such as RNA and being able to submit those data to databases to share it with the community. Compared to de novo assembly where contiguous chromosomes are a sign of high quality, it is difficult to visualize and assess the quality of annotation. We developed the Companion web server to allow non-experts to annotate their genome using a reference-based method, enabling them to assess the output before submitting to public databases. In this update paper, we describe how we have included novel methods for gene finding and made the Companion server more efficient for annotation of genomes of up to 1 Gb in size. The reference set was increased to include genomes of interest for human and animal health from the fungi and arthropod kingdoms. We show that Companion outperforms existing comparable tools where closely related references are available.
Effector Cs02526 from Ciboria shiraiana induces cell death and modulates plant immunity
Authors: Zhang Shuai , Li Ruolan , Fan Wei , Chen Xuefei , Liu Shuman , Zhu Panpan , Gu Xiaohui , Wang Shuchang , Zhao Aichun
Published: May 2024

Sclerotinia disease is one of the most devastating fungal diseases worldwide, as it reduces the yields of many economically important crops. Pathogen-secreted effectors play crucial roles in infection processes. However, key effectors of Ciboria shiraiana, the pathogen primarily responsible for sclerotinia disease in mulberry (Morus spp.), remain poorly understood. In this study, we identified and functionally characterized the effector Cs02526 in C. shiraiana and found that Cs02526 could induce cell death in a variety of plants. Moreover, Cs02526-induced cell death was mediated by the central immune regulator brassinosteroid insensitive 1-associated receptor kinase 1, dependent on a 67-amino acid fragment. Notably, Cs02526 homologs were widely distributed in hemibiotrophic and necrotrophic phytopathogenic fungi, but the homologs failed to induce cell death in plants. Pretreatment of plants with recombinant Cs02526 protein enhanced resistance against both C. shiraiana and Sclerotinia sclerotiorum. Furthermore, the pathogenicity of C. shiraiana was diminished upon spraying plants with synthetic dsRNA-Cs02526. In conclusion, our findings highlight the cell death-inducing effector Cs02526 as a potential target for future biological control strategies against plant diseases.
Luxury brand cars, racial profiling, and citations: Testing the social conditioning model and illusory correlation
Authors: Jackson Leah , Vito Anthony G
Published: May 2024

This study considers the issue of racial profiling in traffic stop citations for young Hispanic male citizens (YHM), young Black male citizens (YBM), and young White male (YWM) citizens stopped while driving a luxury brand car in either majority white cities or majority Hispanic cities. The current study utilized two different datasets: the Illinois traffic stop data (2016–18) and the 2016 LEMAS. The authors used the social conditioning model and illusory correlation as a theoretical explanation for police officer decision-making. The current findings show evidence of racial profiling only for stops involving YHM drivers stopped in majority white cities while driving a luxury brand car for either a safety stop or an investigatory stop ending in a citation. No evidence of racial profiling was found for either YBM drivers stopped in majority white cities or for either YBM drivers or YWM drivers stopped in majority Hispanic cities.
Luddite or technophile?—policy preferences for governing technology-driven economic change
Authors: Lee Jaewook
Published: May 2024

Recent robotics and artificial intelligence advancements have exacerbated fears of technology-driven unemployment and inequality. However, the relationship between automation risks and regulatory policy support remains inconclusive. Moreover, the role of institutional safety net in shaping this connection, and factors influencing preference shifts regarding automation, remain understudied. This study conducts an online survey experiment in the UK and Sweden to address these gaps. First, we find subjective concern, and occupational risks combined with perceived weaker labor market safeguards, lead to calls for automation restriction and job loss compensation. These trends are particularly pronounced in the UK, where institutional protection for workers is less robust. Second, people support accelerating technology-driven change when they see its benefits shared widely, but this shift is mainly observed among individuals relatively safer from automation risks. Our findings suggest strengthening the institutional safety net and envisioning equitable benefit-sharing are crucial for moderating public anxiety toward technology-driven economic change.
The role of YAP/TAZ on joint and arthritis
Authors: Lu Mingcheng , Zhu Mengqi , Wu Zuping , Liu Wei , Cao Chuwen , Shi Jiejun
Published: May 2024

Osteoarthritis (OA) and rheumatoid arthritis (RA) are two common forms of arthritis with undefined etiology and pathogenesis. Yes‐associated protein (YAP) and its homolog transcriptional coactivator with PDZ‐binding motif (TAZ), which act as sensors for cellular mechanical and inflammatory cues, have been identified as crucial players in the regulation of joint homeostasis. Current studies also reveal a significant association between YAP/TAZ and the pathogenesis of OA and RA. The objective of this review is to elucidate the impact of YAP/TAZ on different joint tissues and to provide inspiration for further studying the potential therapeutic implications of YAP/TAZ on arthritis. Databases, such as PubMed, Cochran Library, and Embase, were searched for all available studies during the past two decades, with keywords “YAP,” “TAZ,” “OA,” and “RA.”
Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer: A Population-Based Assessment in the United States [ID 2693178]
Authors: Song Bonnie B. , Anderson Zachary S. , Masjedi Aaron D. , Lee Matthew W. , Mandelbaum Rachel S. , Klar Maximilian , Roman Lynda D. , Wright Jason D. , Matsuo Koji
Published: May 2024

INTRODUCTION:

The objective of this study was to assess population-level utilization and outcome of reproductive-aged patients with early epithelial ovarian cancer (EOC) who underwent fertility-sparing surgery (FSS) in the United States.

METHODS:

This population-based retrospective study queried the National Cancer Institute’s Surveillance, Epidemiology, and End Result Program. The study included 3,027 patients aged less than 50 years with stage I EOC receiving primary surgical therapy from 2007 to 2020. Fertility-sparing surgery was defined as preservation of one ovary and the uterus for unilateral lesion and preservation of the uterus for bilateral lesions. Temporal trend of FSS was assessed with linear segmented regression with log-transformation. Overall survival (OS) associated with FSS was assessed with Cox proportional hazard regression model.

RESULTS:

A total of 534 (17.6%) patients underwent FSS. At cohort level, the utilization of FSS was 13.4% in 2007 and 21.8% in 2020 (P-trend=.009). Non-Hispanic White individuals (2.8-fold), high-grade serous histology (2.2-fold), and stage IC disease (2.3-fold) had greater than 2-fold increase in FSS utilization during the study period (all, P-trend<.05). After controlling for the measured clinico-pathological characteristics, patients who received FSS had OS comparable to those who had nonsparing surgery (5-year rates, 93.6% versus 92.1%; adjusted hazard ratio, 0.87; 95% CI, 0.57–1.35). This survival association was consistent in high-grade serous (5-year rates, 92.9% versus 92.4%), low-grade serous (100% versus 92.2%), clear cell (97.5% versus 86.1%), mucinous (92.1% versus 86.6%), low-grade endometrioid (95.7% versus 97.7%), and mixed histology (93.3% versus 83.7%) (all, P>.05). In high-grade endometrioid tumor, FSS was associated with decreased OS (5-year rates, 71.9% versus 93.8%; adjusted-hazard ratio 2.90; 95% CI, 1.09–7.67). Among bilateral ovarian lesions, FSS was not associated with OS (5-year rates, 95.8% versus 92.5%; P=.364).

CONCLUSION:

Nearly one in five reproductive-aged patients with stage I EOC underwent FSS in recent years in the United States. The data suggest that FSS may not adversely affect OS, except for high-grade endometrioid tumors.
Increased Risk of Adverse Pregnancy Outcomes With Prior COVID-19 Infection [ID 2683650]
Authors: Soudah Chris , Karam Kathleen , Golovko George , Vincent Kathleen L. , Yaklic Jerome L.
Published: May 2024

INTRODUCTION:

Prior retrospective studies found that COVID-19 infection during pregnancy is associated with an increased risk of adverse pregnancy outcomes such as preeclampsia, gestational diabetes, and preterm labor. Our study aims to investigate the risks of adverse pregnancy outcomes associated with COVID-19 infection acquired at least 3 months prior to pregnancy.

METHODS:

De-identified data was obtained from the TriNetX database. Population was stratified to compare women of childbearing age (15–45 years old) who contracted COVID-19 within 3–12 months prior to pregnancy to women without a history of COVID-19. Outcomes were measured within 1 year of pregnancy diagnosis to assess the effects of COVID-19. Statistical analyses used risk ratios (RRs) and P-values less than .05 to measure significance.

RESULTS:

This study identified 5,578 patients who contracted COVID-19 3–12 months prior to pregnancy and 970,218 patients without COVID-19 prior to matching for demographics and diagnoses. Cohorts were balanced (n=5,578 per cohort) using (1:1) propensity score matching for age, sex, race/ethnicity. Patients who contracted COVID-19 prior to pregnancy had a higher risk for preeclampsia (RR 1.428; P<.0001), fetal growth restriction (RR 5.613; P<.0001), and antepartum hemorrhage (RR 1.649; P<.0001). Preterm labor, death, and gestational diabetes were not significant.

CONCLUSION:

Patients who contracted COVID-19 between 3 and 12 months prior to pregnancy have an increased risk for preeclampsia, fetal growth restriction, and antepartum hemorrhage compared to patients without COVID-19. Further investigation is warranted to validate these findings in prospective studies and to guide peripartum care for this population.
Gender-Affirming Hysterectomies: Analysis of Temporal Trends and Characteristics Pre- and Post-Expansion of Health Care Coverage at a Large Integrated California Health Care System [ID 2683540]
Authors: Radoc Jeannie Gail G. , Zhao Yanting , Tucker Lue-Yen , Huynh Ashley , Ritterman Weintraub Miranda L. , Zaritsky Eve
Published: May 2024

INTRODUCTION:

Despite expansion of gender-affirming health care coverage in 2013, few studies have investigated temporal trends in gender-affirming surgeries (GAS) including hysterectomies. Our study aims to investigate the temporal trends of hysterectomies for transgender men and gender-diverse persons (TGD) compared to cisgender women between 2010–2012 and 2013–2019, and annually from 2010 to 2019.

METHODS:

We conducted an observational retrospective cohort study on TGD and cisgendered patients, aged 18 and older, within Kaiser Permanente Northern California (KPNC) between 2010 and 2019. Data on demographics, surgical characteristics, concurrent procedures, and postoperative complications were extracted from electronic medical records. Bivariate comparisons were performed using chi-squared analysis for categorical variables and t-tests for continuous variables.

RESULTS:

This study included 41,341 hysterectomies performed within KPNC between 2010 and 2019. Among all hysterectomies, 461 (1.1%) were for TGD. TGD who underwent hysterectomies were more likely to be younger, White, and nulliparous compared to their cisgender counterparts (P<.05). The incidence of hysterectomies remained similar in cisgender women—from 3,750 (99.7%) in 2010 to 4,361 (98.4%) in 2019. For TGD, the incidence of hysterectomies increased gradually—from 10 (0.3%) in 2010 to 70 (1.6%) in 2019, with the largest increase occurring from 40 (1.0%) hysterectomies in 2014 to 62 (1.5%) in 2015. After expansion of GAS coverage, hysterectomy rates increased eightfold from 55 (0.5%) in 2010–2012 to 406 (1.4%) in 2013–2019.

CONCLUSION:

Gender-affirming hysterectomies have increased substantially because of changes in GAS policies. Future data will evaluate trends of ovarian conservation during concurrent GAS hysterectomy.
Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) for Gender Affirmation [ID 2683658]
Authors: Mohr-Sasson Aya , Hui Mason , Bonilla Moreno Miguel A. , Montealegre Alvaro I.
Published: May 2024

INTRODUCTION:

The process of transitioning from female to male in transgender persons usually includes medical treatment as well as surgical interventions, including removal of the uterus and ovaries. Nulliparity and prolonged exposure of the vaginal mucosa to testosterone, which are common among transgender men, may present challenges to perform a vaginal hysterectomy with salpingo-oophorectomy. The aim of this study is to describe outcomes of vaginal-assisted natural orifice transluminal endoscopic surgery (vNOTES) approach to perform hysterectomy among transgender men as part of their gender-affirming care.

METHODS:

This is a case series observational study conducted at single tertiary medical center including all patients undergoing hysterectomy with bilateral salpingo-oophorectomy by vNOTES approach for gender-affirming care between February 2022 and April 2023. Primary outcome was defined as compound complication rate including intraoperative and postoperative. Patients' demographic and clinical charectaristics were collected from the electronic medical files. Pain at postoperative follow-up was evaluated using visual analog scores, which ranges from 0 (no pain) to 10 (worst pain possible).

RESULTS:

The study population included eight transgender men, all of whom were nulliparous and had undergone testosterone treatment for more than a year. Median age at surgery was 24 years and median body mass index was 30 kg/m2. Mean operative time of the surgery was 111 minutes (range: 91–143 minutes) and none required converting from vNOTES to an alternative approach. No extensive bleeding or organ damage was reported. For one patient, there was one small vaginal laceration requiring suture. All but one patient was discharged the same day. The patient requiring next-day discharge was complicated by postoperative urinary retention. On postoperative follow-up, median pain score was 3 (range: 1–5).

CONCLUSION:

Outcomes from this case series suggest that a vNOTES approach to hysterectomy among transgender men can be performed without surgical complications and with low self-reported pain.
Assessing Pregnant Patients' Postpartum Contraceptive Plans After the SCOTUS Dobbs Decision in a Highly Restrictive State [ID 2683439]
Authors: Mastronardi Alicia , Young Megan Lacy , Oyedeji Oluwafemifola , King Rylee , Maples Jill M. , Zite Nikki
Published: May 2024

INTRODUCTION:

The June 2022 SCOTUS Dobbs decision removed federal protection to abortion access. In August 2022, a Tennessee trigger law made ending a pregnancy for any reason a felony. We hypothesized that this change would result in more pregnant patients desiring highly effective (long-acting or permanent) contraceptive methods after delivery.

METHODS:

This retrospective cohort analysis used electronic health records to capture demographic and pregnancy data for pregnant patients admitted for delivery in one East Tennessee hospital. Documented contraceptive plans chosen during pregnancy were categorized as highly effective (long acting or permanent) or moderate/least effective. Data were extracted from July 2019 to April 2020 (baseline) and compared to July 2022 to April 2023 (post-Dobbs). Chi-squared tests and binary logistic regression were conducted in SPSS.

RESULTS:

One-half (50.6%) of 7,489 records analyzed were post-Dobbs; 90.4% had a documented contraception plan upon hospital admission. Record of choosing a highly effective contraception plan during pregnancy decreased significantly baseline to post-Dobbs (47.2% to 39.6%; P<.001). Logistic regression was used to further analyze the relationship between the Dobbs decision and highly effective contraception plan desired postpartum. Patients who delivered after the Dobbs decision had lower odds (adjusted odds ratio 0.726; 95% CI [0.652, 0.809]; P<.001) of having highly effective contraception plans after controlling for age, number of living children, race/ethnicity, and insurance.

CONCLUSION:

A lower percentage of patients from the post-Dobbs cohort desired highly effective contraception after delivery. Further investigation should explore these surprising results. Regardless, patients should participate in patient-centered contraceptive counseling during prenatal care to make informed decisions after delivery.
Trends in Female Sterilization Since Dobbs v. Jackson at an Academic Institution [ID 2683460]
Authors: Kimble Blair A. , Shiber Linda
Published: May 2024

INTRODUCTION:

The Dobbs v. Jackson United States Supreme Court decision, issued June 24, 2022, fundamentally altered options for addressing unintended pregnancy. This curtailing of access to abortion care may be an inflection point in how individuals capable of becoming pregnant select contraceptive options. We hypothesize that in the immediate wake of the Dobbs v. Jackson decision, those undergoing surgical sterilization will be younger in age and more likely to be nulliparous.

METHODS:

This was a retrospective chart review study. IRB approval was obtained for the study. Using CPT codes, we utilized Epic to identify all patients undergoing surgical sterilizations at an academic, tertiary care hospital during the 12 months preceding the Dobbs decision (June 24, 2021 to June 24, 2022) and the 12 months immediately after the Dobbs decision (June 25, 2022 to June 25, 2023). Charts were reviewed for age, insurance status, highest level of education, gravidity, parity, and type of sterilization procedure, as well as time between request for and completion of surgical sterilization.

RESULTS:

In the 12 months after the Dobbs v. Jackson decision, individuals undergoing female surgical sterilization via salpingectomy or tubal occlusion had a lower mean age and lower mean parity compared to those undergoing sterilization in the 12 months preceding Dobbs.

CONCLUSION:

This study demonstrates that, since the Dobbs v. Jackson decision, individuals seeking female surgical sterilization are younger and less likely to be multiparous. This implies that as access to abortion care in the United States becomes more tenuous, those who seek female surgical sterilization procedures as contraception are younger and lower parity individuals.
Assessment of Pregnancy Desires for Patients With Pregnancy of Unknown Location Seen in the Emergency Department [ID 2683447]
Authors: Doyle Alexis A. , Beshar Isabel , Henkel Andrea , Nief Corrine , Liu Serena , Shorter Jade
Published: May 2024

INTRODUCTION:

Desire for pregnancy should be centered in all discussions surrounding pregnancy management, including management of pregnancy of unknown location (PUL). Little is known about the evaluation of pregnancy desires for patients presenting to the emergency department (ED) found to have PUL.

METHODS:

We performed a retrospective cohort study of patients presenting to a tertiary-care ED with a positive pregnancy test and previously unconfirmed intrauterine pregnancy in the first trimester between January 2020 and December 2022. We excluded patients with chief complaints regarding known intrauterine pregnancy. The primary outcome was documentation of pregnancy desire by the ED provider. The secondary outcome was assessment of pregnancy desiredness by consulting gynecologic providers. Chi-squared and Fisher exact tests assessed for demographic variables. Institutional review board approval was obtained.

RESULTS:

Four hundred ninety-seven patients were included. Overall, only 105 (21.1%) of all patients and 12 (13.5%) patients with PUL were asked about pregnancy desiredness by the ED provider. While not statistically significant, patients with PUL had the lowest rate of being asked their pregnancy desires, compared to patients with confirmed intrauterine pregnancy (22.7%), ongoing miscarriage (28.1%), or ectopic/adnexal pathology (20.0%) (P=.15). Of those asked, 11 patients (10.5%) reported the pregnancy was undesired and 7 (6.7%) were unsure. There were no significant associations between asking pregnancy desires and age, race, ethnicity, parity, insurance, and language. For patients added to the beta book and followed by gynecology, 59.3% of patients were asked about their pregnancy desires.

CONCLUSION:

This study highlights gaps in early pregnancy evaluation and counseling, with only one in five patients asked their pregnancy desires. Patients with adnexal pathology and PUL had among the lowest rates of counseling, compared to those with ongoing miscarriage. This research suggests a missed opportunity for comprehensive pregnancy options counseling and management in the ED and the potential for improvement of care for patients with undesired PUL.
A Descriptive Analysis of a Sample of Hispanic PCOS Patients Living in Puerto Rico [ID 2683511]
Authors: Seguinot-Tarafa Inevy I. , Rosado Torres Claudia S. , Romaguera Josefina , Gonzalez Loida A.
Published: May 2024

INTRODUCTION:

Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies during the reproductive years. Research has shown that Hispanic women with PCOS have the most severe phenotype, in terms of hyperandrogenism and metabolic disturbances. Absence of detailed characterization of PCOS in Puerto Rican patients poses significant barriers to translating research findings into clinical practice. Our aim is to provide an in-depth exploration of the gynecological profile of this population.

METHODS:

This was a cross-sectional study involving 105 female participants aged 21–45 years who underwent clinical evaluation during their routine health visit at endocrinology and gynecology clinics at the UPR-RCM clinics. The study cohort comprised 79 individuals with PCOS and 26 individuals without PCOS. IRB approval number is 2290034657 (B0790117).

RESULTS:

Significant differences were found in the prevalence of oligomenorrhea (90%; P<.001), amenorrhea (94.5%; P<.0004), clinical hirsutism (90.7%; P<.0001), and smoking (97.3%; P<.0001) among PCOS patients. These results align with existing literature on PCOS patients. There were no significant differences in menarche, thelarche, metrorrhagia, menorrhagia, sociodemographic profile, or toxic habits between the two groups. Additionally, both groups exhibited similarly high body mass index, fasting blood sugar, and hemoglobin A1C levels.

CONCLUSION:

Our study population’s characteristics align with those reported in other studies. However, the observed metabolic disturbances in our control group may be attributed to unique factors prevalent within the Puerto Rican population. Although this research contributes valuable insights, it is essential to acknowledge the study’s limitations, particularly the relatively small sample size. Further investigation and broader sampling are warranted to substantiate and refine these initial findings.
Pain Without Prejudice: Examining Disparities in Endometriosis and Pelvic Pain Management Stratified by Race in an Integrative Health Care System [ID 2683558]
Authors: Hen Eden , Childs Aliyya , Zaritsky Eve , Wicks Carla , Ritterman Weintraub Miranda L. , Tucker Lue-Yen
Published: May 2024

INTRODUCTION:

Approximately 10% of reproductive-aged women suffer from endometriosis; racial variations in prevalence and treatment are unknown. Black women are often undertreated for pain and medical conditions. This study assessed variations in pelvic pain and endometriosis management with particular emphasis on Black versus non-Black patients.

METHODS:

We conducted a retrospective cohort study of women 18 years and older with pelvic pain disorders, including endometriosis, pelvic pain, dysmenorrhea, and dyspareunia, coded within the Kaiser Permanente Northern California electronic medical record between 2012 and 2019. Demographic, clinical, and treatment characteristics were assessed overall and by patient race/ethnicity.

RESULTS:

Of 15,164 eligible study participants, 1,707 (11.3%) were Black, 6,735 (50.1%) White, 2,097 (15.6%) Asian, 3,762 (28%) Latinx, and 863 (6%) unknown. Black compared to non-Black women were younger (36 [interquartile range (IQR) 28–44] versus 37 [IQR 30–45]; P<.001), had a higher body mass index (29.8 [IQR 25.2–35.9] versus 26 [IQR 22.7–30.7] kg/m2; P<.001) and similar parity. A higher proportion of Black women received hormonal therapy (56.2% versus 51.9%; P<.001). When stratified by all races, this was explained by White women receiving the least amount of hormonal therapy (56.2% versus 49.8%; P<.001). Black women received more pain medications (55.4% versus 44.7%; P<.001), with no racial variations in rates of laparoscopic surgery (4.4 versus 4.9; P=.21). Fewer Black women received referrals to a pelvic pain specialist (14.5% versus 17.8%; P=.001), and when stratified by all races White women received more referrals (21%; P<.001). There were no racial variations in patients who received medical followed by surgical treatment.

CONCLUSION:

Black women received more hormonal, pain, and similar surgical management, in contrast to that reported in prior publications. However, all races had a lower pelvic pain specialist referral rate than White patients. These findings illustrate the need to better understand the allocation of care in patients with pelvic pain disorders, including endometriosis.