bluuebunny/crossref_metadata_2025 huggingface dataset:
Initiating and Continuing Long-Term Exercise in Heart Failure
Authors: Platz Katherine , Metzger Maureen , Cavanagh Casey , Park Linda , Howie-Esquivel Jill
Published: February 2024

Background

Exercise is a class 1A recommendation to improve the lives of patients with heart failure, yet less than one-third adhere to physical activity guidelines, and less than 3% attend cardiac rehabilitation.

Objective

The aim of this study was to determine the effect of gentle nonaerobic exercise on initial and long-term adherence in patients with heart failure.

Methods

We used a qualitative descriptive approach with qualitative content analysis to analyze previously recorded interview data collected as part of the 6-month GEtting iNTo Light Exercise–Heart Failure study and looked for trends in responses among our sample. Thematic statements, representing salient aspects of the participants' experiences, were created and supported by illustrative excerpts from the data.

Results

Twenty-two interviews were analyzed. Eight participants had ≥80% adherence, and the remaining 14 participants were super-adherers (>100% adherence). Super-adherers tended to be male and 65 years or older, and have no exercise for 3 months before the study, a body mass index ≥ 30, and poor to good Kansas City Cardiomyopathy Questionnaire scores. Participants initially enrolled because they saw the program as an opportunity to improve a health issue and to exercise. Long-term adherence was facilitated by convenience, individualization, experiencing psychological and physical improvements, and peer fellowship.

Conclusions

The GEtting iNTo Light Exercise–Heart Failure study that used home-based gentle nonaerobic exercise had 64% of participants come more than was asked. It is imperative that clinicians incorporate what participants with heart failure have directly stated is important for their initiation and long-term adherence to exercise so that we can work toward bridging sedentary patients to the full exercise guidelines to reduce morbidity and mortality.
Factors Influencing Intent to Stay for Faculty in Physical Therapist Education Programs: A Mixed-Methods Analysis
Authors: Jumper Jill , Gleeson Peggy , Mitchell Katy , Bogardus Jennifer
Published: February 2024

Introduction.

In May 2022, the American Council of Academic Physical Therapy announced a “nationwide shortage of faculty” in entry-level Doctor of Physical Therapy (DPT) programs across the country. As the number of physical therapist education programs continue to grow, concerns with faculty shortages increase.

Review of Literature.

Research on reasons faculty stay in entry-level DPT programs is limited. With a nation-wide shortage of faculty and the continued growth of DPT programs across the country, more investigation into faculty retention is warranted.

Subjects.

Two hundred forty-four participants responded to the quantitative survey. Ten program directors (PD) and 10 faculty members (FM) completed a qualitative interview through Zoom.

Methods.

This mixed-methods design included a quantitative survey across 264 accredited DPT programs followed by 20 qualitative online interviews. Multiple regression was completed for the data analysis, and a phenomenological approach was used to explore perceptions of job satisfaction and organizational commitment on intent to stay.

Results.

Two hundred thirty-six subjects (mean age = 50.04 ± 9.54 years; males = 63, females = 173; PD = 55, FM = 180) were included in the analysis. The multiple regression model significantly predicted intent to stay for all participants, F(9,211) = 12.43, P < .001; adj R
2 = .32. Commitment to the organization was the greatest predictor of intent to stay, β = 0.61, t(0.622) = 5.05, P < .01. Three themes with 6 subthemes emerged from the qualitative analysis, the impact of leadership, making a commitment, and the Covid crisis.

Conclusion and Discussion.

Encouraging leadership to focus on structural factors such as striving to establish FMs as part of the departmental team, allowing autonomy and flexibility in the teaching role, building transparency and openness with communication, and focusing on realistic and equitable workloads could potentially increase intent to stay for faculty in entry-level DPT programs.
Comparison of intravascular lithotripsy and rotational atherectomy for the treatment of heavily calcified coronary lesions: the STIFF (Stenoses with calcificaTIon treated with angioplasty eFFected with dedicated interventional tools) study
Authors: Garzon Stefano , Bezerra Felipe , Mariani José , Bandeira Willterson , Prado Guy , Rueda Victor , Almeida Breno , Lemos Pedro
Published: February 2024

Background

Percutaneous coronary interventions in heavily calcified coronary lesions are associated with technical difficulties and the worse prognosis. Lesion preparation is important to reduce complications and improve outcomes. The aim of this study is to compare the results of rotational atherectomy (RA) and intravascular lithotripsy (IVL) at achieving optimal stent implantation using intravascular ultrasound criteria.

Methods

Retrospective, single-center study comparing patients with heavily calcified coronary lesions that underwent percutaneous coronary interventions using RA or IVL.

Results In total

25 patients (13 in the RA group and 12 in the IVL group) were included. Reference vessel diameter was similar between the groups [2.59 (2.51–3.63) mm in the RA group vs. 2.79 (2.59–3.16) mm in the IVL group; P = 0.89], as were minimal lumen area [1.02 (0.80–1.23) mm vs. 1.40 (1.01–1.40) mm; P = 0.43] and diameter stenosis [60.4% (52.3–72.3) vs. 56.1% (47.8–61.3); P = 0.56). The final minimal lumen area was significantly larger in the IVL group [7.6 mm2 (5.8–8.6) vs. 5.4 mm2 (4.5–6.2); P = 0.01] as were lumen area gain [4.1 mm2 (2.6–5.9) vs. 2.3 mm2 (1.4–3.6); P = 0.01] and final stent volume [491.2 mm3 (372.2–729.8) vs. 326.2 mm3 (257.1–435.4); P = 0.03]. In the RA group, 69.2% of the patients achieved the preestablished intravascular ultrasound-based criteria for successful stent implantation, vs. 100% of the patients in the IVL group (P = 0.04).

Conclusion

Patients in the IVL group achieved the Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation trial criteria of successful stent implantation more frequently than those treated with RA.
Efficacy and safety of restrictive versus liberal blood transfusion strategies in acute myocardial infarction and anemia: a systematic review and meta-analysis of randomized controlled trials
Authors: Amin Ahmed Mazen , Ali Karim , Elbenawi Hossam , Saber Alhassan , Abuelazm Mohamed , Abdelazeem Basel
Published: February 2024

Background

Blood transfusion strategies in patients with acute myocardial infarction (AMI) and anemia are yet to be conclusively identified. Thus, we aim to assess the efficacy and safety of restrictive versus liberal blood transfusion strategies for AMI and anemia.

Methods

A systematic review and meta-analysis of randomized controlled trials (RCTs) retrieved from PubMed, web of science, SCOPUS, EMBASE, and Cochrane Central Register of Controlled Trials were performed through November 2023. We used RevMan V. 5.4 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD) with a 95% confidence interval (CI). (PROSPERO): ID: CRD42023490692.

Results

We included four RCTs with 4.325 patients. There was no significant difference between both groups regarding MACE whether at 30 days (RR: 0.93 with 95% CI [0.57–1.51], P = 0.76) or ≥ six months (RR: 1.17 with 95% CI [0.95–1.45], P = 0.14), all-cause mortality at 30 days (RR: 1.16 with 95% CI [0.95–1.40], P = 0.14) or ≥ six months (RR: 1.16 with 95% CI [0.88–1.53], P = 0.28). However, the liberal strategy was significantly associated with increased hemoglobin level change (MD: −1.44 with 95% CI [−1.68 to −1.20], P < 0.00001). However, the restrictive strategy was significantly associated with a lower incidence of acute lung injury (RR: 0.11 with 95% CI [0.02–0.60], P = 0.01).

Conclusion

There was no significant difference between the restrictive blood transfusion strategy and the liberal blood transfusion strategy regarding the clinical outcomes. However, restrictive blood transfusion strategy was significantly associated with a lower incidence of acute lung injury than liberal blood transfusion strategy.
Biopsy-based transcriptomics in the diagnosis of kidney transplant rejection
Authors: de Nattes Tristan , Beadle Jack , Roufosse Candice
Published: February 2024

Purpose of review

The last year has seen considerable progress in translational research exploring the clinical utility of biopsy-based transcriptomics of kidney transplant biopsies to enhance the diagnosis of rejection. This review will summarize recent findings with a focus on different platforms, potential clinical applications, and barriers to clinical adoption.

Recent findings

Recent literature has focussed on using biopsy-based transcriptomics to improve diagnosis of rejection, in particular antibody-mediated rejection. Different techniques of gene expression analysis (reverse transcriptase quantitative PCR, microarrays, probe-based techniques) have been used either on separate samples with ideally preserved RNA, or on left over tissue from routine biopsy processing. Despite remarkable consistency in overall patterns of gene expression, there is no consensus on acceptable indications, or whether biopsy-based transcriptomics adds significant value at reasonable cost to current diagnostic practice.

Access to biopsy-based transcriptomics will widen as regulatory approvals for platforms and gene expression models develop. Clinicians need more evidence and guidance to inform decisions on how to use precious biopsy samples for biopsy-based transcriptomics, and how to integrate results with standard histology-based diagnosis.
Cystatin C should be routinely available for estimating kidney function
Authors: Lees Jennifer S. , Fabian June , Shlipak Michael G.
Published: February 2024

Purpose of review

In this report, we summarize why the availability of cystatin C is important across a variety of clinical scenarios, the recent literature on when, why and in whom cystatin C testing should be considered, and how nephrologists can take practical steps to incorporate cystatin C testing into their practice.

Recent findings

Large intra-individual discrepancies between estimated glomerular filtration rate by creatinine (eGFRcr) and estimated glomerular filtration rate by creatinine eGFRcys (known as eGFRdiff) are observed in at least 1 in 4 people. These differences are seen more commonly among more vulnerable individuals: older adults, females, non-White individuals and those living with multiple medical conditions. A large eGFRdiff, where eGFRcys is lower than eGFRcr, is associated with a plethora of adverse outcomes, including medication-associated adverse events, acute kidney injury, cardiovascular disease, kidney failure and all-cause mortality. Among studies that have measured GFR, eGFRcr-cys usually provides the most accurate estimation of kidney function compared to mGFR, including among participants with large discrepancies between eGFRcr and eGFRcys.

Cystatin C improves sensitivity and specificity of chronic kidney disease diagnosis, improves detection of harmful acute and chronic changes in kidney function, improves precision of treatment eligibility and safety, and may reduce healthcare inequalities. Better education, curiosity, and motivation among nephrologists could substantially improve the availability and utilization of cystatin C.
Precision care in the treatment of pediatric asthma
Authors: Mahmood Lina , Keskin Sevdenur , Jefferson Akilah A.
Published: February 2024

Purpose of review

Precision medicine in pediatric asthma involves identification of asthma phenotypes, genetic markers, biomarkers, and biologics that target specific pathways. This review includes a discussion of the efficacy of currently approved biologics for pediatric asthma and most recent advances in biomarker/phenotype identification and genetic associations that affect asthma care.

Recent findings

Biologics targeting type-2 mediated pathways have shown success in the treatment of moderate to severe asthma in pediatric and adult patients. In comparative studies, dupilumab, an interleukin-4 (IL-4) alpha receptor inhibitor, and mepolizumab, an IL-5 inhibitor, have shown more improvement in asthma exacerbation rates and lung function compared to other biologics such as tezepelumab, omalizumab and benralizumab. Other methods used to categorize asthma treatment response have been investigated and include use of biomarkers such as fractional exhaled nitric oxide (FeNO). Genomic studies are also emerging in precision care for pediatric asthma.

An understanding of underlying immunologic and genetic mechanisms affecting the development of asthma in pediatric patients has resulted in the production of numerous targeted therapies that have led to improvement in lung function and reduced exacerbation burden.
Hypoglycemia Associated With PEG-asparaginase and 6-MP Therapy During Treatment of Acute Lymphoblastic Leukemia in Pediatric Patients: A Case Series
Authors: Jiang Mary R. , Ahmet Alexandra , Lawrence Sarah , Bassal Mylene , Speckert Matthew , Geraghty Michael T. , Somerville Scott
Published: February 2024

Background:

Asparaginases are a mainstay treatment for pediatric acute lymphoblastic leukemia (ALL). Recent reports identified hypoglycemia associated with asparaginases. Other reports describe hypoglycemia associated with 6-mercaptopurine (6-MP), another fundamental ALL therapy. Little is known about the risk of hypoglycemia associated with ALL therapy, an adverse event that puts children at risk of decreased level of consciousness, seizures, and possibly negative neurocognitive sequelae.

Methods:

We performed a retrospective chart review of 6 children with hypoglycemia during ALL treatment in our institution from May 2016 to August 2019. Timing and duration of hypoglycemia relative to polyethylene glycol (PEG)–asparaginase, 6-MP, and corticosteroids were determined. Laboratory values of the critical sample were collected.

Results:

The median age was 2.75 (interquartile range: 1.88 to 3.63) years. Three patients had trisomy 21. The onset of hypoglycemia was 5 to 19 days after the most recent PEG-asparaginase administration or 6 to 7 months after initiating daily 6-MP. Sixteen hypoglycemic events were documented, and 9/16 had a critical sample drawn. Six events were hypoketotic, associated with PEG-asparaginase. Three were ketotic, associated with 6-MP. Two patients required treatment with diazoxide and cornstarch.

Conclusions:

Hypoglycemia associated with PEG-asparaginase occurred later and lasted longer than previous reports with l-asparaginase, with the likely mechanism being hyperinsulinism. 6-MP was associated with ketotic hypoglycemia.
Cardiorespiratory fitness in persons with lower limb amputation
Authors: van Schaik Loeke , Blokland Ilse J. , van Kammen Klaske , Houdijk Han , Geertzen Jan H.B. , Dekker Rienk
Published: February 2024

The aim of this study is to gain insight in the cardiorespiratory fitness of persons with lower limb amputation (LLA) during rehabilitation, and in potential factors influencing their cardiorespiratory fitness. We performed a retrospective cohort study using data from cardiopulmonary exercise tests. Included participants were adults with LLA. Main outcome was cardiorespiratory fitness expressed as

O2 peak (ml/min/kg) and was directly determined using breath-by-breath gas analysis.

O2 peak was compared to reference values for able-bodied controls. Multivariate regression analysis was performed to investigate potential factors related to

O2 peak in persons with LLA. Potential factors were age, BMI adjusted, gender, level of amputation, aetiology of amputation, unilateral/bilateral, type of ergometry and use of beta blockers. Data of 74 participants with LLA are presented; 84% male (n = 62), mean age 58.9 (SD 11.6), mean BMI 26.7 (SD 5.6), 44 participants have a LLA above the knee, 30 below the knee. Overall

O2 peak was lower in persons with LLA compared to reference values for able-bodied controls, with mean

O2 peak for the total LLA group of 14.6 ± 4.1 ml/kg/min. In the multivariate regression analysis, only age was a significant predictor for lower

O2 peak (regression coefficient: −0.15, 95% CI [0.23–0.069], r2 = 0.166). These results indicate that the cardiorespiratory fitness in persons with LLA is low, while they actually need more energy to walk and perform other daily activities. Cardiorespiratory fitness is not closely associated with the analysed demographic or clinical factors and will have to be determined on an individual basis for use in daily practice.
A randomized controlled trial comparing pioglitazone and metformin prior to in vitro fertilization in polycystic ovary syndrome – associated infertile women: impact on pregnancy rates
Authors: Taheripanah Robabeh , Kazemi Seyyedeh N. , Taheripanah Anahita , Fereidoonjah Somayyeh
Published: February 2024

Background:

Polycystic ovarian syndrome (PCOS) is one of the significant causes of infertility. Impaired glucose metabolism and insulin resistance add chiefly to the pathogenesis of PCOS. This study aimed to evaluate the efficacy of metformin and pioglitazone (insulin sensitizers) on the quality of the ovum and pregnancy rate in the IVF cycle.

Methods:

In this randomized clinical trial study, 172 infertile women with PCO were enrolled and randomly assigned to receive either 15 mg pioglitazone (case group) or 1000 mg metformin (control group) twice a day for 6 weeks before IVF, and the pregnancy rate was compared across the groups. The number of ovum and embryos were also accessed and compared between the two groups.

Results:

In the study, 172 patients participated. The mean age in the control and case groups was 32.09±3.9 years and 32.12±3.9 years, respectively, with no significant age difference. In both groups, the mean number of IVF eggs retrieved was 11.76±3.7 (control) and 11.86±3.7 (case), and the number of embryos formed was 7.43±2.8 (control) and 7.87±3.5 (case), with no significant disparities (P<0.05). Regarding positive pregnancies, 28 out of 86 (32.6%) occurred in the control group, while 42 out of 86 (48.8%) happened in the case group, demonstrating a significant difference (P=0.03).

Conclusions:

According to the results obtained in this study, it may be concluded that pioglitazone is superior to metformin in IVF cycles in PCOS-associated infertile women leading to a higher pregnancy rate.
Lutembacher syndrome presenting as heart failure in an old female from rural Nepal: a case report
Authors: Chaudhary Durgesh , Adhikari Pratik , Mehta Binod , Yadav Pramodman Singh , Koirala Sagar , Shah Sumit Kumar , Khadka Manita
Published: February 2024

Introduction and significance:

Lutembacher syndrome (LS), combining atrial septal defect (ASD) and mitral stenosis (MS), is rare, particularly in rural areas. This case presents a 55-year-old Nepalese woman with LS symptoms; however, financial constraints hindered surgical treatment, highlighting LS challenges and the need for early intervention in resource-limited settings.

Case presentation:

A 55-year-old woman from rural Nepal presented with 30-day leg swelling and shortness of breath. Apart from autosomal dominant polycystic kidney disease (ADPKD) and smoking, she had no significant comorbidities. Clinical examination revealed severe mitral stenosis and an ASD, but financial limitations prevented surgery.

Clinical discussion:

LS is rarer in regions with low rheumatic heart disease (RHD) prevalence like Nepal. This case, despite rarity, delayed presentation, and financial barriers, emphasizes early intervention’s importance. While rheumatic fever wasn’t confirmed, clinical and echocardiographic findings suggest rheumatic mitral stenosis. The patient’s surgery reluctance due to finances highlights resource limitations’ impact.

Conclusion:

This Nepalese LS case highlights its complexity and management challenges, especially in resource-limited settings. It stresses early intervention’s importance and the impact of financial constraints on patient care. The study urges improved healthcare access and alternative funding in high RHD-prevalence regions.
Association of Systemic Immune-Inflammation Index With Stroke and Mortality Rates
Authors: Yang Lei , Wang Maode
Published: February 2024

Objective:

This study aimed to examine the association of the systemic immune-inflammation index (SII) with stroke and mortality rates using data from the National Health and Nutrition Examination Survey (NHANES).

Methods:

A cross-sectional study was conducted using the aggregated data from 5 cycles (2009 to 2018) of NHANES. SII was the independent variable, and stroke was the dependent variable. Weighted logistic regression models were employed to analyze their relationship. The nonlinear association between SII and stroke was examined using the restricted cubic spline (RCS) method in subgroups stratified by smoking status, hypertension, and dietary inflammatory index. Weighted Kaplan-Meier curves and Cox regression analysis were used to investigate the association of SII with all-cause mortality and cardiovascular disease (CVD) mortality.

Results:

A total of 22,107 samples were included in this study. Weighted logistic regression analysis showed a significant correlation between SII and stroke (OR: 1.53, 95% CI: 1.22-1.92, P<0.001). The stratified analysis revealed that interactions of smoking status and hypertension with SII, respectively, had significant impacts on stroke risk. A remarkable positive link between SII and stroke risk (OR>1, P<0.05) was observed in the crude model (unadjusted for confounding factors), model I (adjusted for demographic characteristics), and model II (adjusted for all confounding factors). RCS analysis displayed a remarkable nonlinear positive correlation between SII and stroke risk only in the “now smoking” population (P-nonlinear<0.05) after adjusting for all confounding factors. In the overall sample population, Kaplan-Meier curves indicated that individuals in the highest quartile of SII had the highest risk of all-cause mortality and CVD mortality (log-rank test P<0.05). Samples with proinflammatory dietary habits had considerably higher risks of all-cause mortality and CVD mortality compared with those with anti-inflammatory dietary habits (log-rank test P<0.05). Multivariable-adjusted Cox regression models showed significantly increased all-cause mortality and CVD mortality rates in the highest quartile of SII compared with the lowest quartile.

Conclusions:

SII levels were considerably positively linked to stroke risk, particularly in the “now smoking” population. Moreover, elevated SII levels increased the risk of all-cause mortality and CVD mortality in the overall population. On the basis of these findings, we recommend incorporating smoking cessation measures into stroke risk reduction strategies.
Development of psycho-oncology telehealth guidelines: a modified Delphi consensus study
Authors: Cooper Claire , Gilchrist Jemma , Beatty Lisa , Kirsten Laura , Sharpe Louise , Zomerdijk Nienke , Grier Maree , Turner Jane , Hobbs Kim , Haydon Helen M. , Dhillon Haryana , Kelly Brian , Shaw Joanne
Published: February 2024

Objective:

In response to COVID-19, psycho-oncology clinicians moved to a model of telephone and videoconference treatment in Australia. The Psycho-oncology Co-operative Research Group (PoCoG) identified a paucity of evidence available to guide adaptation of therapy for remote delivery. This research aimed to develop consensus for evidence-based guidelines on ways to adapt psychological therapies in psycho-oncology for remote delivery.

Methods:

A national expert advisory group (N = 11) was convened consisting of psycho-oncology clinicians and clinical researchers. An iterative codesign methodology was used to draft psycho-oncology telehealth guidelines. Australian psycho-oncology clinicians participated in a Delphi consensus process to guide the content included in the guidelines. Content was presented under six domains: (i) screening and outcome measures, (ii) formulation, (iii) safety considerations, (iv) resource adaptation, (v) adaptations to therapy, and (vi) example case studies. Participants rated items based on importance, therapeutic appropriateness, and/or usefulness. Consensus was defined as >80% agreement.

Results:

Thirty-two psycho-oncology clinicians with telehealth experience participated in three Delphi rounds. Agreement was reached on (i) the importance of including screening and outcome measures (90%) and items (n = 5) related to how best to facilitate this; (ii) the importance of addressing provision of a formulation (100%), although only 2/6 strategies presented to facilitate formulation reached consensus; (iii) the appropriateness of proposed risk assessment and management strategies (84%); (iv) therapeutic appropriateness of simplifying resources (100%), including 3/5 visual optimization strategies; and (v) common behavioral components of therapy (n=5).

Conclusions:

Providing guidance to psycho-oncology clinicians for integrating telehealth into routine clinical practice must go beyond logistical considerations. These consensus-based guidelines provide support to clinicians for adaptation of psycho-oncology therapy to telehealth and will ensure evidence-based practice.
Femicide in the United States
Authors: Alexander Abigail L. , Gill James R.
Published: February 2024

We examined the records of the Connecticut Office of the Chief Medical Examiner for all female homicides from 2012 to 2021 to ascertain the rate of femicide. The investigative data were subcategorized as femicides and nonfemicides. The records included autopsy, toxicology, and investigators' reports. All underwent autopsy examination. The relationship of the perpetrator, cause of death, and special circumstances were examined in conjunction with the United Nations operational criteria. If the death investigation did not identify the suspected perpetrator, news media were searched for a reported homicide or manslaughter arrest. The total number of homicides was 271, and 259 (96%) could be further categorized, of which 181 (70%) were femicides. Differences between the 2 cohorts included causes of death (P's < 0.001), age at death (P < 0.001), and the involvement of murder-suicide (P < 0.001). No differences were observed for race, and the yearly rate of femicides did not increase during the COVID-19 pandemic.
American Association of Plastic Surgeons Consensus on Breast Implant–Associated Anaplastic Large-Cell Lymphoma
Authors: Clemens Mark W. , Myckatyn Terence M. , Di Napoli Arianna , Feldman Andrew L. , Jaffe Elaine S. , Haymaker Cara L. , Horwitz Steven M. , Hunt Kelly K. , Kadin Marshall E. , McCarthy Colleen M. , Miranda Roberto N. , Prince H. Miles , Santanelli di Pompeo Fabio , Holmes Sari D. , Phillips Linda G.
Published: February 2024

Background:

In the absence of high-quality evidence, there is a need for guidelines and multidisciplinary consensus recommendations on breast implant–associated anaplastic large-cell lymphoma (BIA-ALCL). The purpose of this expert consensus conference was to evaluate the existing evidence regarding the diagnosis and management of BIA-ALCL caused by textured implants. This article aims to provide evidence-based recommendations regarding the management and prevention of BIA-ALCL.

Methods:

A comprehensive search was conducted in the MEDLINE, Cochrane Library, and Embase databases, and supplemented by manual searches of relevant English-language articles and “related articles” sections. Studies focusing on breast surgery and lymphoma associated with breast implants were included for analysis. Meta-analyses were performed and reviewed by experts selected by the American Association of Plastic Surgeons using a Delphi consensus method.

Results:

A total of 840 articles published between January of 2011 and January of 2023 were initially identified and screened. The full text of 188 articles was assessed. An additional 43 articles were excluded for focus, and 145 articles were included in the synthesis of results, with 105 of them being case reports or case series. The analysis encompassed a comprehensive examination of the selected articles to determine the incidence, risk factors, clinical presentation, diagnostic approaches, and treatment modalities related to BIA-ALCL.

Conclusions:

Plastic surgeons should be aware of the elevated risks by implant surface type, implement appropriate patient surveillance, and follow the recommendations outlined in this statement to ensure patient safety and optimize outcomes. Ongoing research on the pathogenesis, genetic drivers, and preventative and prophylactic measures for BIA-ALCL is crucial for improving patient care.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, V.
Systemic inflammation in pregnant women with HIV: relationship with HIV treatment regimen and preterm delivery
Authors: Shivakoti Rupak , Giganti Mark J. , Lederman Michael M. , Ketchum Rachel , Brummel Sean , Moisi Daniela , Dadabhai Sufia , Moodley Dhayendre , Violari Avy , Chinula Lameck , Owor Maxensia , Gupta Amita , Currier Judith S. , Taha Taha E. , Fowler Mary Glenn ,   for the PROMISE study team
Published: February 2024

Objective:

HIV treatment regimen during pregnancy was associated with preterm delivery (PTD) in the PROMISE 1077 BF trial. Systemic inflammation among pregnant women with HIV could help explain differences in PTD by treatment regimen. We assessed associations between inflammation, treatment regimen, and PTD.

Design/methods:

A nested 1 : 1 case–control study (N = 362) was conducted within a multicountry randomized trial comparing three HIV regimens in pregnant women: zidovudine alone, or combination antiretroviral therapy (ART) with lopinavir/ritonavir and either zidovudine or tenofovir. Cases were women with PTD (<37 weeks of gestational age). The following inflammatory biomarkers were measured in plasma samples using immunoassays: soluble CD14 (sCD14) and sCD163, intestinal fatty acid-binding protein, interleukin (IL)-6, interferon γ, and tumor necrosis factor α. We fit regression models to assess associations between second trimester biomarkers (measured before ART initiation at 13–23 weeks of gestational age and 4 weeks later), treatment regimen, and PTD. We also assessed whether inflammation was a mediator in the relationship between ART regimen and PTD.

Results:

Persistently high interleukin-6 was associated with increased PTD. Compared with zidovudine alone, the difference in biomarker concentration between week 0 and week 4 was significantly higher (P < 0.05) for both protease inhibitor-based regimens. However, the estimated proportion of the ART effect on increased PTD mediated by persistently high biomarker levels was 5% or less for all biomarkers.

Conclusion:

Persistently high IL-6 during pregnancy was associated with PTD. Although protease inhibitor-based ART was associated with increases in inflammation, factors other than inflammation likely explain the increased PTD in ART-based regimens compared with zidovudine alone.
Brief Report: Self-Reported HIV-Positive Status but Subsequent HIV-Negative Test Results in Population-Based HIV Impact Assessment Survey Participants—11 Sub-Saharan African Countries, 2015–2018
Authors: Logan Naeemah Z. , Kilmarx Peter H. , Rolle Italia , Patel Hetal K. , Duong Yen T. , Lee Kiwon , Shang Judith D. , Bodika Stephane , Koui Isabelle T. , Balachandra Shirish , Li Michelle , Brown Kristin , Nuwagaba-Biribonwoha Harriet , Getaneh Yimam , Lulseged Sileshi , Haile Ashenafi , West Christine A. , Mengistu Yohannes , McCracken Stephen D. , Kalua Thokozania , Jahn Andreas , Kim Evelyn , Wadonda-Kabondo Nellie , Jonnalagadda Sasi , Hamunime Ndapewa , Williams Daniel B. , McOllogi Juma James , Mgomella George S. , Mdodo Rennatus , Kirungi Wilford L. , Mugisha Veronicah , Ndongmo Clement B. , Nkwemu Kennedy Chibeta , Mugurungi Owen , Rogers John H. , Saito Suzue , Stupp Paul , Justman Jessica E. , Voetsch Andrew C. , Parekh Bharat S.
Published: February 2024

Background:

HIV testing is a critical step to accessing antiretroviral therapy (ART) because early diagnosis can facilitate earlier initiation of ART. This study presents aggregated data of individuals who self-reported being HIV-positive but subsequently tested HIV-negative during nationally representative Population-Based HIV Impact Assessment surveys conducted in 11 countries from 2015 to 2018.

Method:

Survey participants aged 15 years or older were interviewed by trained personnel using a standard questionnaire to determine HIV testing history and self-reported HIV status. Home-based HIV testing and counseling using rapid diagnostic tests with return of results were performed by survey staff according to the respective national HIV testing services algorithms on venous blood samples. Laboratory-based confirmatory HIV testing for all participants identified as HIV-positives and self-reported positives, irrespective of HIV testing results, was conducted and included Geenius HIV-1/2 and DNA polymerase chain reaction if Geenius was negative or indeterminate.

Results:

Of the 16,630 participants who self-reported as HIV-positive, 16,432 (98.6%) were confirmed as HIV-positive and 198 (1.4%) were HIV-negative by subsequent laboratory-based testing. Participants who self-reported as HIV-positive but tested HIV-negative were significantly younger than 30 years, less likely to have received ART, and less likely to have received a CD4 test compared with participants who self-reported as HIV-positive with laboratory-confirmed infection.

Conclusions:

A small proportion of self-reported HIV-positive individuals could not be confirmed as positive, which could be due to initial misdiagnosis, deliberate wrong self-report, or misunderstanding of the questionnaire. As universal ART access is expanding, it is increasingly important to ensure quality of HIV testing and confirmation of HIV diagnosis before ART initiation.
Serum Extracellular Vesicle Protein Profiling for Prediction of Corneal Transplant Rejection
Authors: Lee Hyun Ju , Bae Eun-Hye , Choi Jong Min , Kim Hyemee , Kim Hyeon Ji , Barreda Heather , Jung Sung Yun , Oh Joo Youn , Lee Ryang Hwa
Published: February 2024

Background.

Corneal transplantation is the most common transplant procedure worldwide. Despite immune and angiogenic privilege of the cornea, 50% to 70% of corneal transplants fail in high-risk recipients, primarily because of immune rejection. Therefore, it is crucial to identify predictive biomarkers of rejection to improve transplant survival.

Methods.

In search for predictive biomarkers, we performed proteomics analysis of serum extracellular vesicles (EVs) in a fully major histocompatibility complex–mismatched (C57BL/6-to-BALB/c) murine corneal transplantation model, wherein 50% of transplants undergo rejection by day 28 following transplantation.

Results.

Our time course study revealed a decrease in the number of serum EVs on day 1, followed by a gradual increase by day 7. A comparative analysis of proteomics profiles of EVs from transplant recipients with rejection (rejectors) and without rejection (nonrejectors) found a distinct enrichment of histocompatibility 2, Q region locus 2, which is a part of major histocompatibility complex-class I of donor C57BL/6 mice, in day 7 EVs of rejectors, compared with nonrejectors, syngeneic controls, or naïve mice. In contrast, serum amyloid A2, a protein induced in response to injury, was increased in day 7 EVs of nonrejectors.

Conclusions.

Our findings offer noninvasive EV-based potential biomarkers for predicting corneal allograft rejection or tolerance.
Improved Waitlist Outcomes in Liver Transplant Patients With Mid-MELD-Na Scores Listed in Centers Receptive to Use of Organs Donated After Circulatory Death
Authors: Miyake Katsunori , Chau Lucy C. , Trudeau Sheri , Kitajima Toshihiro , Wickramaratne Niluka , Shimada Shingo , Nassar Ahmed , Gonzalez Humberto C. , Venkat Deepak , Moonka Dilip , Yoshida Atsushi , Abouljoud Marwan S. , Nagai Shunji
Published: February 2024

Background.

Liver transplant (LT) using organs donated after circulatory death (DCD) has been increasing in the United States. We investigated whether transplant centers’ receptiveness to use of DCD organs impacted patient outcomes.

Methods.

Transplant centers were classified as very receptive (group 1), receptive (2), or less receptive (3) based on the DCD acceptance rate and DCD transplant percentage. Using organ procurement and transplantation network/UNOS registry data for 20 435 patients listed for LT from January 2020 to June 2022, we compared rates of 1-y transplant probability and waitlist mortality between groups, broken down by model for end-stage liver disease-sodium (MELD-Na) categories.

Results.

In adjusted analyses, patients in group 1 centers with MELD-Na scores 6 to 29 were significantly more likely to undergo transplant than those in group 3 (aHR range 1.51–2.11, P < 0.001). Results were similar in comparisons between groups 1 and 2 (aHR range 1.41–1.81, P < 0.001) and between groups 2 and 3 with MELD-Na 15–24 (aHR 1.19–1.20, P < 0.007). Likewise, patients with MELD-Na score 20 to 29 in group 1 centers had lower waitlist mortality than those in group 3 (scores, 20–24: aHR, 0.71, P = 0.03; score, 25–29: aHR, 0.51, P < 0.001); those in group 1 also had lower waitlist mortality compared with group 2 (scores 20–24: aHR0.69, P = 0.02; scores 25–29: aHR 0.63, P = 0.03). One-year posttransplant survival of DCD LT patients did not vary significantly compared with donation after brain dead.

Conclusions.

We conclude that transplant centers’ use of DCD livers can improve waitlist outcomes, particularly among mid-MELD-Na patients.
Differential transcriptional profiles of vagal sensory neurons in female and male mice
Authors: Jo Young-Hwan
Published: February 2024

The differences in metabolic homeostasis, diabetes, and obesity between males and females are evident in rodents and humans. Vagal sensory neurons in the vagus nerve ganglia innervate a variety of visceral organs and use specialized nerve endings to sense interoceptive signals. This visceral organ-brain axis plays a role in relaying interoceptive signals to higher brain centers as well as in regulating the vago-vagal reflex. I hypothesized that molecularly distinct populations of vagal sensory neurons would result in differences in metabolic homeostasis between the sexes. Single-nucleus RNA sequencing analysis of vagal sensory neurons from females and males reveals differences in the transcriptional profiles of cells in the vagus nerve ganglia. These differences are linked to the expression of sex-specific genes such asXist, Tsix, andDdx3y. Among the 13 neuronal clusters, one-fourth of the neurons in male mice are located in theDdx3y-enriched VN1 and VN8 clusters, which display a higher enrichment ofTrpv1, Piezo2, Htr3a, andVipgenes. In contrast, 70% of the neurons in females are found inXist-enriched clusters VN4, 6, 7, 10, 11, and 13, which show enriched genes such asFgfr1, Lpar1, Cpe, Esr1, Nrg1, Egfr, andOprm1. Two clusters of satellite cells are identified, one of which in males contains some oligodendrocyte precursor cells. A small population of cells expressUcp1andPlin1, indicating that they are epineural adipocytes. Understanding the physiological consequences of differences in these transcriptomic profiles on energy balance and metabolic homeostasis would help develop sex-specific treatments for obesity and metabolic dysregulation.
A multiscale model of the mammalian liver circadian clock supports synchronization of autonomous oscillations by intercellular communication
Authors: Marri Daniel , Kana Omar , Filipovic David , Sluka James P. , Liu Shengnan , Zhang Qiang , Bhattacharya Sudin
Published: February 2024

Expression of core circadian clock genes in hepatocytes across the liver lobule is temporally synchronized despite cell-autonomous oscillations in gene expression. This spatial synchronization has been attributed to an unknown intercellular coupling mechanism. Here we have developed multicellular computational models of the murine liver lobule with and without intercellular coupling to investigate the role of synchronization in circadian gene expression. Our models demonstrated that intercellular coupling was needed to generate sustained circadian oscillations with a near 24-hour period. Without coupling the simulated period was variable within the 21-28-hour range. Further model analysis revealed that a robust near-24-hour oscillation period can be generated with a wide range of circadian protein degradation rates. In contrast, only a small window of circadian gene transcription rates was able to generate realistic oscillatory periods. The coupled model accurately captured the temporal dynamics of circadian genes derived from single-nuclei transcriptomic data. Overall, this study provides novel insights into the mammalian hepatic circadian clock through modeling of spatial and temporal gene expression patterns and data-driven analysis.
Cellular mechanisms underlying beneficial versus detrimental effects of bacterial antitumor immunotherapy
Authors: Castillo Jesse Garcia , Fernandez Sebastian , Campbell Timothy , Gonzalez-Ventura Diego , Williams Jacob , Ybarra Julia , Hernandez Nicole Flores , Wells Elina , Portnoy Daniel A. , DuPage Michel
Published: February 2024

Bacteria engineered to express tumor antigens as a cancer vaccine have yielded mixed results. Here, we utilized an attenuated strain ofListeria monocytogenes(ΔactA, Lm) that does not express tumor antigen to explore the immunological response toListeriaitself in the context of intravenous (IV), intratumoral (IT), or a combination of IV+IT administration into tumor-bearing mice. Unexpectedly, we found thatLmpersisted in tumors of immune competent mice, regardless of the administration route. While ITLmalone led to the recruitment of immunosuppressive immune cells that promoted tumor growth, IVLmfollowed by ITLmcontrolled tumor growth. IVLmvaccination generated a pool of anti-Lmcytotoxic CD8 T cells that killedLm-infected non-tumor cells to control tumor growth both indirectly, by limiting cancer cell proliferation, and directly, by enhancing tumor-specific T cell responses. Our findings reveal a differential impact of ITLmadministration on tumor progression that depends on the presence of anti-LmCD8 T cells, which alone are sufficient to promote therapeutic efficacy.
The influence of talus size and shape onin vivotalocrural hopping kinematics
Authors: Behling Anja-Verena , Kelly Luke , Welte Lauren , Rainbow Michael J
Published: February 2024

Talus implants often come in standard sizes and shapes; however, humans vary in their bone size and shape. Consequently, patient-specific implants are becoming available. Understanding how shape changes alter function in a healthy cohort may help designers determine how much specificity is required in talocrural implants.

Nine participants (5 females) hopped on one leg while biplanar video radiography and force plate data were collected. 3D bone models were created from computed tomography scans. Helical axes of motion were calculated for the talus relative to the tibia (rotation axes) and a cylinder was fit through the talar dome (morphological axis). Bland-Altman plots and spatial angles tested whether the rotation and morphological axes agree. A shape model of 36 (15 females) participants was established and a cylinder fit was morphed through the range of ±3 standard deviations.

The rotation and morphological axes largely agree regarding their orientation and location during hopping. The morphological axis consistently overestimates the orientation-component in anterior-posterior direction. Some shape components affect talar dome orientation and curvature independent of size. This suggests that besides size, the shape of the talar dome might affect the movement pattern during locomotion. Our findings are important to inform talocrural joint arthroplasty design.
Population model of epigenetic inheritance of acquired adaptation to changing environments
Authors: Osmanović Dino , Rabin Yitzhak , Soen Yoav
Published: February 2024

Accumulated evidence of transgenerational inheritance of epigenetic and symbiotic changes begs the question of under which conditions inheritance of acquired changes can confer long-term advantage to the population. To address this question, we introduce a population epigenetics model of individuals undergoing stochastic and/or induced changes that are transmitted to the offspring. Potentially adaptive and maladaptive responses are represented, respectively, by environmentally driven changes that reduce and increase the individuals’ rate of death (i.e. reduction and increase of selective pressure). Analytic solution in a simplified case of exposure to two types of dynamic environments shows that inheritance of changes that transiently alleviate the selective pressure confers long-term advantage even when the transmitted state is maladaptive to the offspring. The benefits of inheriting environmentally driven changes that reduce the death rate within a lifetime include escape from extinction under a wide range of conditions. These advantages are even more pronounced in populations with imperfect inheritance and/or age-dependent decline in fertility. These findings show that inheritance of non-genetic changes can have tremendous benefits for the population on timescales that are much longer than the lifetime of an individual.
Dysregulation of mitochondrial function by PLK1-mediated PDHA1 phosphorylation promotes Cr(VI)-associated lung cancer progression
Authors: Zhang Qiongsi , Li Zhiguo , Rao Xiongjian , Allison Derek B. , Qiao Qi , Zhang Zhuangzhuang , Kong Yifan , Zhang Yanquan , Wang Ruixin , Liu Jinghui , Wang Xinyi , Li Chaohao , Mao Fengyi , Katz Wendy , Shao Qing , Gao Tianyan , Liu Xiaoqi
Published: February 2024

Hexavalent chromium (Cr(VI)) is a class I environmental carcinogen known to induce lung epithelial cell transformation and promote lung cancer progression through alterations in the cell cycle and cellular energy metabolism. In this study, we investigated the role of polo-like kinase 1 (PLK1) in Cr(VI)-transformed (CrT) bronchial epithelial cells (BEAS-2B) and found that PLK1 expression was significantly upregulated in CrT cells, leading to impaired mitochondrial function and enhanced cell proliferation both in vitro and in vivo. High levels of PLK1 in CrT cells resulted in decreased mitochondrial activity due to defective modulation of pyruvate dehydrogenase E1 subunit alpha 1 (PDHA1), which is crucial for pyruvate/Acetyl-CoA conversion and carbon influx into the tricarboxylic acid (TCA) cycle. Mechanistically, we demonstrated that PLK1 directly phosphorylates PDHA1 at T57, leading to E1 collapse and PDHA1 degradation via activation of mitophagy. These defects resulted in the inhibition of oxidative phosphorylation and reduction of mitochondrial superoxide generation, ultimately leading to suppression of mitochondrial-mediated apoptotic response. Our findings highlight the role of PLK1 in metabolic reprogramming during Cr(VI)-associated cancer progression, providing new insights and a potential therapeutic target to inhibit Cr(VI)-induced cancer development. Moreover, PLK1 inhibitors may also have the potential to increase chemo-sensitivity of cancer cells by restoring normal mitochondrial function, thereby mitigating drug resistance caused by mitochondrial dysfunction and hyperpolarization.