bluuebunny/crossref_metadata_2025 huggingface dataset:
522. CAN PREHABILITATION IMPROVE HEALTH-RELATED QUALITY OF LIFE OF PATIENTS DURING NEOADJUVANT CHEMOTHERAPY FOR ESOPHAGOGASTRIC ADENOCARCINOMA?
Authors: Chmelo Jakub , Navidi Maziar , Sinclair Rhona CF , Greystoke Alastair , Phillips Alexander W
Published: September 2022

Prehabilitation is designed to improve patients’ functional capacity prior to operation in order to better withstand stress of surgery and therefore improve patients’ postoperative outcomes. It is not known whether prehabilitation of patients with esophagogastric adenocarcinoma (EGA) can also improve patients’ centred outcomes. The aim of this study was to assess whether prehabilitation can lead to better health-related quality of life (HRQoL) during neoadjuvant chemotherapy (NAC) treatment for EGA.

Patients enrolled into a prospective home-based prehabilitation study (ChemoFit) during NAC for EGA had their HRQoL measured using validated EORTC QLQ-C30 and QLQ-OG25 questionnaires prior NAC and prior to surgery (post-NAC). ChemoFit patients were compared with historical cohort (NO-PREHAB) which did not undergo prehabilitation and which had their HRQoL assessed in the same way during identical time points. Prehabilitation consisted of daily aerobic sessions with step-count target and daily strengthening exercises, under weekly telephone supervision. Mann U Whitney test was used for statistical comparison.

There were 31 patients in ChemoFit group and 24 patients in NO-PREHAB cohort. Statistically significant intergroup differences were observed for scores of global quality of life (mean score difference ChemoFit +12.9 vs NO-PREHAB -2.4, p=0.003), physical functioning (+5.8 vs -4.9, p=0.002), role functioning (1.6 vs -13.5, p=0.022) and for symptoms of fatigue (-6.6 vs 9.7, p=0.008) and nausea/vomiting (-10.2 vs 0.7, p=0.030).

Patients prehabilitated within ChemoFit study achieved better scores in several HRQoL scales including global quality of life in comparison to historical cohort which did not undergo prehabilitation. These results suggest that prehabilitation of patients with EGA might lead to improvement of their HRQoL prior to operation. It is unknown whether this difference would persist after operation. It is desirable to confirm these findings within randomised controlled trial setting.
571. ESOPHAGEAL PERFORATION AFTER LOBECTOMY: PADLOCK CLIP TO THE RESCUE
Authors: Cheng Shi Yu , Lim Jolene , Voon Kelvin
Published: September 2022

Esophageal perforation or fistula is a devastating condition with diagnostic and therapeutic challenges. It is associated with high morbidity and mortality due to its rapid progression to mediastinitis or peritonitis, septic shock and multiorgan failure. Iatrogenic perforation is the commonest in this era.

We hereby report a case of esophagopulmonary fistula following a right lower lobectomy which was successfully treated with endoscopic clipping. A 52-year-old man presented with productive cough and weigh loss for 2 weeks. Initial workup in another center revealed right lung lower lobe lesion and a right lower lobectomy was done. Saliva and food particle were noted in chest drain on post-operative day 2 due to esophageal perforation.

Re-thoracotomy, washout and esophageal repair was done. An open window thoracostomy was created for further drainage and parenteral nutrition was initiated. Histology of the lobectomy specimen revealed actinomycosis of right lung. However, there was persistent leak from the esophagus with suspicion of esophagopulmonary fistula. He was then transferred to our center for further treatment. OGDS revealed a 5mm defect at right lateral wall mid thoracic esophagus, about 28cm from incisor, with healthy and supple surrounding mucosa. Contrast study revealed esophagopulmonary fistula. Esophageal defect was successfully closed with over-the-scope padlock clip (Steris). Repeat contrast study 1 week later revealed resolution of fistula.

Sepsis and source control, nutritional support with restoration of gastrointestinal tract intergrity are key steps in the management of esophageal perforation. Endoscopic treatment is efficacious, less invasive, and with the advantage of organ preservation. Endoscopic clipping is safe and effective in selected group of patients with esophageal perforation or fistula.
638. SAFETY AND EFFICACY OF REPEATED TALAPORFIN SODIUM PHOTODYNAMIC THERAPY (PDT) FOR ESOPHAGEAL CANCER
Authors: Tamaoki Masashi , Yokoyama Akira , MItani Yosuke , Horimatsu Takahiro , Ohashi Shinya , Katada Chikatoshi , Muto Manabu
Published: September 2022

While Talaporfin sodium photodynamic therapy (PDT) is an effective and safety salvage treatment for local failure after chemoradiotherapy for esophageal cancer, some case developed local failure. For such case, repeated PDT could be indicated. However, safety and efficacy of repeated PDT as a salvage treatment for esophageal cancer has not been elucidated.

We retrospectively reviewed 60 patients with esophageal cancer who were treated with salvage PDT at Kyoto University Hospital between October 2015 and August 2021.

Among 60 patients, repeated PDT after the first PDT was indicated for 21 lesions in 16 patients (26.7%), of which eight lesions were residual tumor, four were local recurrence after complete response (CR) after the first PDT at the primary site, and nine were metachronous lesion. The total session of repeated PDT was 33; 20 were for primary sites and 13 were for metachronous sites. Among them, seven patients (43.8%) achieved local (L) -CR and 13 lesions (61.9%) achieved lesion L-CR. By session, 14 sessions (42.4%) achieved L-CR. There were no severe adverse events except for one patient of perforation.

Repeated PDT could be an effective and safe treatment option for local failure after salvage PDT for esophageal cancer.
Prediction of Crohn’s Disease Stricturing Phenotype Using aNOD2-derived Genomic Biomarker
Authors: Ashton James J , Cheng Guo , Stafford Imogen S , Kellermann Melina , Seaby Eleanor G , Cummings, J R Fraser , Coelho Tracy A F , Batra Akshay , Afzal Nadeem A , Beattie R Mark , Ennis Sarah
Published: September 2022

Background

Crohn’s disease (CD) is highly heterogenous and may be complicated by stricturing behavior. Personalized prediction of stricturing will inform management. We aimed to create a stricturing risk stratification model using genomic/clinical data.

Methods

Exome sequencing was performed on CD patients, and phenotype data retrieved. Biallelic variants in NOD2 were identified. NOD2 was converted into a per-patient deleteriousness metric (“GenePy”). Using training data, patients were stratified into risk groups for fibrotic stricturing using NOD2. Findings were validated in a testing data set. Models were modified to include disease location at diagnosis. Cox proportional hazards assessed performance.

Results

Six hundred forty-five patients were included (373 children and 272 adults); 48 patients fulfilled criteria for monogenic NOD2-related disease (7.4%), 24 of whom had strictures. NOD2 GenePy scores stratified patients in training data into 2 risk groups. Within testing data, 30 of 161 patients (18.6%) were classified as high-risk based on the NOD2 biomarker, with stricturing in 17 of 30 (56.7%). In the low-risk group, 28 of 131 (21.4%) had stricturing behavior. Cox proportional hazards using the NOD2 risk groups demonstrated a hazard ratio (HR) of 2.092 (P = 2.4 × 10-5), between risk groups. Limiting analysis to patients diagnosed aged < 18-years improved performance (HR-3.164, P = 1 × 10-6). Models were modified to include disease location, such as terminal ileal (TI) disease or not. Inclusion of NOD2 risk groups added significant additional utility to prediction models. High-risk group pediatric patients presenting with TI disease had a HR of 4.89 (P = 2.3 × 10-5) compared with the low-risk group patients without TI disease.

Conclusions

A NOD2 genomic biomarker predicts stricturing risk, with prognostic power improved in pediatric-onset CD. Implementation into a clinical setting can help personalize management.
Introduction
Authors: Busch Danny , Gortsos Christos V , McMeel Gerard
Published: September 2022

This is the introductory chapter of the book. It explains that the book offers a thorough overview, analysis, and discussion of the liability regimes which apply to financial supervisors and resolution authorities at EU level, at the level of selected individual EU Member States, and in major jurisdictions worldwide. It offers a unique and thorough access to a topic that is of great practical and theoretical importance. The book also contains a thorough comparative law evaluation.
Liability of the European Financial Authorities
Authors: Busch Danny , Gortsos Christos V
Published: September 2022

This chapter provides an overview and discussion of the liability of the European financial authorities. Such are: (i) the European Securities and Markets Authority (ESMA), (ii) the European Banking Authority (EBA), (iii) the European Insurance and Occupational Pensions Authority (EIOPA), (iv) the European Systemic Risk Board (ESRB), (v) the European Central Bank (ECB), (vi) and the Single Resolution Board (SRB).
Germany
Authors: Binder Jens-Hinrich
Published: September 2022

This chapter explores the fundamental principles for liability of supervisory authorities within Germany, which essentially follows more general patterns of state liability for negligent breaches of duties by public officials more generally. As guaranteed by the German Constitution, the state will be liable if a public official, when discharging his or her duties under administrative law, is found to have breached a duty towards individuals (or companies) and has done so at least negligently. As a consequence of legislation introduced in the aftermath of the Herstatt failure in 1974, however, financial supervisors under German law are generally deemed to discharge their duties only ‘in the public interest’, which effectively precludes liability towards individuals. The chapter explains the background and the consequences of that doctrine, and discusses whether liability might nonetheless arise in the context of obligations enshrined in European law.
France
Authors: Bonneau Thierry
Published: September 2022

The liability of the French financial and the French banking authorities is not so common a question. The legal framework is limited. The main source of liability standard is case law. The French financial authority and the French banking authority are not exactly in the same situation because of their respective status. Only the financial authority has legal personality. It implies that the banking authority is not in itself liable for negligence, misconduct, or inadequate behaviour. The French state is therefore liable in this latter case. This difference is without consequence on the conditions on which liability depends: a fault/negligence, damage, and a cause connection. In many cases, gross negligence/gross fault must be proved. Consequently, the question is to determine the significance and the extent of this concept. The result is that it is not easy to engage the liability of the authorities and the French state as regards losses suffered by clients.
Italy
Authors: Perrone Andrea
Published: September 2022

The liability of financial supervisors under Italian law stands out for a checkered course. After decades of case law declining jurisdiction in civil liability cases against public authorities, since the mid-1990s, in a few instances, courts awarded damages to investors for losses caused by negligent supervision. In the early 2000s, the pendulum swung back. A statutory restriction made financial supervisors’ liability conditional on intent or gross negligence, and new cases withered. The national act implementing the Bank Recovery and Resolution Directive extended the same restriction to the resolution authority. Following the crisis of some local banks, however, a few cases, in part still pending, were brought against financial supervisors and the resolution authority in most recent times. This chapter discusses liability standards, addresses the liability of financial supervisors in practice, and offers a comprehensive evaluation of the relevant matter.
Spain
Authors: Muñoz David Ramos , García Elia Cerrato , Argachal Carlos Bosque
Published: September 2022

This chapter discusses on the liability of financial supervisors and resolution authorities in Spain. Those authorities are: (i) the Banco de España (BdE) for banking, (ii) the Comisión Nacional del Mercado de Valores (CNMV) for securities, (iii) the Dirección General de Seguros y Fondos de Pensiones (DGSFP) for insurance and re-insurance, and (iv) the Fondo de Reestructuración Ordenada Bancaria (FROB), as national resolution authority. Following a long-standing tradition, financial supervisors’ liability in Spain is subject to the general requisites that determine public authorities’ liability. This general background, however, does not fully capture how liability is appraised in practice, its nuances, and the reluctance of courts to find the authorities liable. Therefore, the comprehensive analysis of the relevant case law undertaken in this chapter studies the standard of review applied by Spanish courts in cases (potentially) involving financial supervisors´ (and resolution authorities’) liability. The chapter further analyses the consistency of such liability regime (and the applied standard of review) with the requirements that determine the liability of Union bodies under EU Law, and concludes that Spanish courts’ attitude may evolve as the interest in implementing consistent supervisory practices across Member States increases.
Portugal
Authors: Morais Luís Silva , Feteira Lúcio Tomé
Published: September 2022

Tortious liability of financial supervisors (including those that exercise resolution functions) in Portugal is governed by the specific tort law regime applicable to the state and other public entities in Portugal. The liability criteria provided for the tortious liability regime for the state and other public entities are largely aligned with general tort liability rules, notwithstanding some important differences in several requirements. The chief purpose of this chapter is to discuss and evaluate in practice the tortious liability of financial supervisors having regard of the institutional supervisory model adopted in Portugal, which includes the Bank of Portugal (Banco de Portugal, which is simultaneously the central bank and the financial supervisor for the banking sector, for as much as this competence is retained at national level vis-à-vis the Single Supervisory Mechanism, with resolution functions), the Portuguese Insurance and Pension Funds Authority (Autoridade de Seguros e Fundos de Pensões), and the Portuguese Securities Market Commission (Comissão de Mercado de Valores Mobiliários).
United Kingdom
Authors: McMeel Gerard
Published: September 2022

This chapter examines the potential civil liability to depositors and investors of the financial supervisory authorities—the Prudential Regulation Authority, the Financial Conduct Authority, and the Bank of England—in the UK. Both at common law and by express statutory provision significant hurdles have been erected for claimants in such cases, including a general requirement of bad faith and difficulties establishing causation, and therefore there have been no successful reported cases. In contrast various public inquiries have revealed very significant failures in supervision of financial firms in the UK, but where compensation has eventually been paid, in cases where political pressure has made it difficult for governments to refuse, such sums have been ex gratia and typically modest.
Australia
Authors: Paterson Jeannie Marie , Paterson Ian
Published: September 2022

Australia has been spared recent collapses of significant financial institutions. The powers of Australian regulators to resolve a failing institution have not been tested in the courts. The Australian Prudential Regulation Authority (APRA) and the Australian Securities and Investments Commission are given broad immunities from suit by potential claimants, except in respect of conduct not in good faith. It is likely that this would allow claims for intentional torts, such as the tort of misfeasance in public office. Cases where the elements of that tort could be made out by an affected institution, depositor, or other counterparty to that institution should be rare. In addition, the Commonwealth Constitution provides some protection against regulatory action that might be characterized as an acquisition of property that is not on just terms. An action by APRA that had this character could give rise to a statutory ground for compensation against the Commonwealth.
Automatic classification of galaxy morphology based on the RegNetX-CBAM3 algorithm
Authors: Li Juan , Tu Liangping , Gao Xiang , Li Xin , Zhong Zhengdi , Feng Xueqi
Published: September 2022

This paper focuses on the automatic classification of galaxy morphology based on deep learning. Through applying a variety of improvement strategies and comparing the results of a large number of experiments, an algorithm named RegNetX-CBAM3 with good performance is proposed to implement the task of automatic classification of galaxy morphology. The RegNetX-CBAM3 algorithm is applied along with many other popular neural networks in the data set consisting of the Extraction de Formes Idéalisées de Galaxies en Imagerie (EFIGI) catalogue and Galaxy Zoo 2 (GZ2), and there are the following seven types of the galaxy morphology in this data set: lenticular, barred spiral, spiral, completely round smooth, in-between smooth, cigar-shaped smooth, and irregular, respectively. Experimental results show that the RegNetX-CBAM3 algorithm achieves the state-of-the-art results over many other excellent algorithms, with the accuracy of 0.9202, purity of 0.9214, completeness of 0.9213, F1-score of 0.9210, and AUC value of 0.9827 on the test set. Moreover, we establish a method of probability confidence calculation considering the classification bias. The confidence degree of galaxies calculated by this method is basically consistent with that of GZ2 and EFIGI, which demonstrates the rationality of this method and also proves that the RegNetX-CBAM3 algorithm can effectively classify galaxies. Therefore, the RegNetX-CBAM3 algorithm can be applied to effectively solve the problem of automatic classification of galaxy morphology. On EFIGI data, the performance of the RegNetX-CBAM3 algorithm does not change substantially with the redshift range. In addition, it should be noted that the use of deep neural networks, manual annotation, and data enhancement may cause classification bias in galaxy images.
Can accreting primordial black holes explain the excess radio background?
Authors: Acharya Sandeep Kumar , Dhandha Jiten , Chluba Jens
Published: September 2022

The excess radio background seen at ${\simeq}0.1\rm{-}10\, {\rm GHz}$ has stimulated much scientific debate in the past years. Recently, it was pointed out that the soft photon emission from accreting primordial black holes may be able to explain this signal. We show that the expected ultraviolet photon emission from these accreting black holes would ionize the universe completely at z > 6 and thus wash out the 21-cm absorption signature at z ≃ 20 as well as be in tension with existing cosmic microwave background anisotropy and average spectral distortion limits. We discuss possible augmentations of the model; however, it seems that an explanation of radio excess by accreting primordial black holes is not well-justified.
Testing general relativity using quasi-periodic oscillations from X-ray black holes: XTE J1550-564 and GRO J1655-40
Authors: Rink Katherine , Caiazzo Ilaria , Heyl Jeremy
Published: September 2022

We use the Relativistic Precession Model (RPM) and quasi-periodic oscillation (QPO) observations from the Rossi X-ray Timing Explorer to derive constraints on the properties of the black holes that power these sources and to test general relativity (GR) in the strong field regime. We build upon past techniques by using pairs of simultaneously measured QPOs, rather than triplets, and by including characteristic frequencies from the broad noise components of the power spectra in our fits. We find the inclusion of these broad noise components causes an overestimate in masses and underestimate in spins compared to values derived independently from optical spectra. We extend the underlying space-time metric to constrain potential deviations from the predictions of GR for astrophysical black holes. To do this, we modify the RPM model to a Kerr–Newman–deSitter space-time and model changes in the radial, ecliptic, and vertical frequencies. We compare our models with X-ray data of XTE J1550-564 and GRO J1655-40 using robust statistical techniques to constrain the parameters of the black holes and the deviations from GR. For both sources, using QPO and characteristic frequency data, we constrain particular deviations from GR to be less than one part per thousand.
CMB power spectra and cosmological parameters from Planck PR4 with CamSpec
Authors: Rosenberg Erik , Gratton Steven , Efstathiou George
Published: September 2022

We present angular power spectra and cosmological parameter constraints derived from the Planck PR4 (NPIPE) maps of the cosmic microwave background. NPIPE, released by the Planck Collaboration in 2020, is a new processing pipeline for producing calibrated frequency maps from Planck data. We have created new versions of the CamSpec likelihood using these maps and applied them to constrain the lambda cold dark matter (ΛCDM) model and single-parameter extensions. We find excellent consistency between NPIPE and the Planck 2018 maps at the parameter level, showing that the Planck cosmology is robust to substantial changes in the mapmaking. The lower noise of NPIPE leads to ~10 per cent tighter constraints, and we see both smaller error bars and a shift towards the ΛCDM values for beyond-ΛCDM parameters including ΩK and AL.
iPro-WAEL: a comprehensive and robust framework for identifying promoters in multiple species
Authors: Zhang Pengyu , Zhang Hongming , Wu Hao
Published: September 2022

Promoters are consensus DNA sequences located near the transcription start sites and they play an important role in transcription initiation. Due to their importance in biological processes, the identification of promoters is significantly important for characterizing the expression of the genes. Numerous computational methods have been proposed to predict promoters. However, it is difficult for these methods to achieve satisfactory performance in multiple species. In this study, we propose a novel weighted average ensemble learning model, termed iPro-WAEL, for identifying promoters in multiple species, including Human, Mouse, E.coli, Arabidopsis, B.amyloliquefaciens, B.subtilis and R.capsulatus. Extensive benchmarking experiments illustrate that iPro-WAEL has optimal performance and is superior to the current methods in promoter prediction. The experimental results also demonstrate a satisfactory prediction ability of iPro-WAEL on cross-cell lines, promoters annotated by other methods and distinguishing between promoters and enhancers. Moreover, we identify the most important transcription factor binding site (TFBS) motif in promoter regions to facilitate the study of identifying important motifs in the promoter regions. The source code of iPro-WAEL is freely available at https://github.com/HaoWuLab-Bioinformatics/iPro-WAEL.
Enhancing Patient Choice: Using Self-administered Intranasal Naloxone for Novel Rapid Buprenorphine Initiation
Authors: Randall Adam , Hull Ilana , Martin Stephen A.
Published: September 2022

Buprenorphine-naloxone (BUP-NX) is a lifesaving treatment for opioid use disorder. The increasing use of illicitly manufactured fentanyl, however, has made initiating BUP-NX more likely to precipitate withdrawal—an experience that deters treatment and causes return to use. If BUP-NX cannot be successfully started, it cannot work. We describe the case of a patient who was able to transition to a therapeutic dose of BUP-NX less than 3 hours after his last illicitly manufactured fentanyl use by choosing to self-administer intranasal naloxone. After the naloxone, the transition took 31 minutes, including 14 minutes of expected moderately severe withdrawal. He remains in care with BUP-NX and would recommend this transition approach to others.
Trajectories of Patient-Reported Outcomes After Palliative Gastrointestinal Surgery in Advanced Cancer
Authors: Wong Jolene S. M. , Ng Irene A. T. , Juan Wen Kai D. , Ong Whee Sze , Yang Grace M. , Finkelstein Eric A. , Gandhi Mihir , Ong Chin-Ann J. , Seo Chin Jin , Zhu Hong-Yuan , Chia Claramae S.
Published: September 2022

Objective:

To evaluate the trajectories and sustainability of health-related quality of life (HRQoL) outcomes after palliative gastrointestinal (GI) surgery and perioperative factors associated with HRQoL improvement postsurgery.

Background:

Palliative patients face a wide range of physical, emotional, social, and functional challenges. In evaluating the efficacy of palliative surgical interventions, a major pitfall of traditional surgical outcome measures is that they fall short of measuring outcomes that are meaningful to patients during end-of-life. HRQoL tools may provide a more comprehensive assessment of the true value and impact of palliative surgery.

Methods:

We prospectively recruit advanced cancer patients undergoing palliative GI surgery. The Functional Assessment of Cancer Therapy—General (FACT-G) questionnaire was administered before and at regular intervals after surgery. HRQoL improvement was defined as ≥4-points increment in FACT-G total score over baseline. Duration of sustained HRQoL improvement above this threshold and factors associated with varying extents of HRQoL change were evaluated.

Results:

Of the 65 patients, intestinal obstruction was the most common indication for surgery (70.8%). The mean baseline FACT-G total score was 70.7 (95% CI: 66.3–75.1). Forty-six (70.8%) patients experienced HRQoL improvement after surgery. This HRQoL improvement was sustained over a median duration of 3.5 months and was driven mainly by improvements in patients’ physical and emotional well-being. Albumin was significantly associated with the extent of HRQoL improvements (P = 0.043).

Conclusion:

A clinically significant and sustained improvement in HRQoL was observed after palliative GI surgery. Patients with higher preoperative albumin levels were more likely to experience HRQoL improvements.
Reliability of Current Classification Systems for Periprosthetic Fractures of the Humerus
Authors: Auran Richard L. , Tran Tram L. , Dehghan Niloofar , McKee Michael D. , Lederman Evan S.
Published: September 2022

Objective:

Numerous classification systems exist to evaluate periprosthetic humerus fractures, although most are based on limited patient numbers. The Wright and Cofield system is the most widely used classification system. We sought to evaluate the interobserver and intraobserver reliabilities of this system compared with the Unified Classification System (UCS) using the largest patient sample to date.

Methods:

This retrospective study identified patients between December 2011 and January 2021 with a periprosthetic fracture of the humerus around the stem of a shoulder arthroplasty component. Three upper extremity fellowship-trained surgeons evaluated all radiographs for stem stability, evidence of preinjury stem loosening, Wright and Cofield classification, UCS classification, and recommended treatment for each case at 2 timepoints separated by 2 months. The kappa statistic for interobserver and intraobserver reliability was calculated.

Results:

Seventy-six patients were included. There was moderate interobserver (kappa 0.53) and substantial intraobserver (kappa 0.69) agreement when classifying stem stability after fracture. There was moderate interobserver (kappa 0.48) and intraobserver (kappa 0.60) agreement when evaluating for stem loosening before fracture. There was fair interobserver (kappa 0.29) and moderate intraobserver (kappa 0.51) agreement regarding the UCS class. There was moderate interobserver (kappa 0.41) and intraobserver (kappa 0.57) agreement regarding the proposed treatment. There was slight interobserver (kappa 0.04) and moderate intraobserver (kappa 0.44) agreement regarding the Wright and Cofield classification.

Conclusion:

The Wright and Cofield system is less reliable than the UCS classification. A more reliable and clinically relevant classification system is needed to standardize discussion of periprosthetic proximal humerus fractures.
Description of Opioid-involved Hospital Deaths that Do Not Have a Subsequent Autopsy
Authors: Abasilim Chibuzor , Holloway-Beth Alfreda , Friedman Lee S.
Published: September 2022

Background:

Surveillance systems rely on death records to monitor the most severe outcome of the opioid epidemic. However, few studies have linked data from hospital systems with death records to determine potential undercount of opioid-involved deaths occurring in hospitals. This study describes characteristics of decedents less likely to have an autopsy following an opioid-involved death in hospitals and estimates the resulting undercount.

Methods:

A probabilistic data linkage of hospital and medical examiner data involving 4,936 opioid-involved deaths among residents of Cook County, Illinois, US from 2016 to 2019. We included only hospital deaths that met a national case definition and presented with clinical signs of opioid overdose.

Results:

Decedents had higher odds of not having an autopsy if they were 50+ years, admitted to the hospital (aOR = 3.7: 2.1, 6.5), hospitalized for 4+ days (aOR = 2.2: 1.5, 3.1), and had a comorbid diagnosis of malignant cancer (aOR = 4.3: 1.8, 10.1). However, decedents exposed to heroin and synthetic opioids (aOR = 0.39: 0.28, 0.55), and concurrent exposure to stimulants (aOR = 0.44: 0.31, 0.64) were more likely to have an autopsy). Compared to estimates from the US Centers for Disease Control and Prevention (CDC), we observed undercounts of opioid overdose deaths ranging from 6% to 15%.

Conclusions:

Surveillance systems may undercount decedents that do not meet the typical profile of those more likely to have an autopsy, particularly older patients with chronic health conditions. Our undercount estimate likely exists in addition to the estimated 20%–40% undercount reported elsewhere. See video abstract at, http://links.lww.com/EDE/B990.
CNM/CMs Fill the Gap in Rural Maternal Care
Authors: Coleman Lastascia Nicole Granger
Published: September 2022

The United States is in the midst of a maternity care crisis. A key driver is workforce shortages, which impacts maternity care service delivery in rural areas significantly. The midwifery model of care remains underutilized. Midwifery care delivered by certified nurse-midwives and certified midwives is heavily endorsed and supported in the extant literature, but no firm national actions have been taken to move recommendations into funding or practice. Certified nurse-midwives and Certified Midwives are able to care for low-risk pregnancies and are uniquely situated to address factors associated with social determinants of health in rural areas. One of the solutions to the rural maternity care crisis is scaling up the midwifery workforce. Individual, institutional, state, and federal factors are discussed.
Race-based Versus Race-conscious Medicine in Obstetrics and Gynecology
Authors: O’Brien Joselle , Clare Camille A.
Published: September 2022

Race is a social and power construct whose meaning has shifted over time. Racist beliefs in medicine fostered the continuation of these notions. In this commentary, we review race-based medicine versus race-conscious medicine. Race-conscious medicine emphasizes racism as a key determinant of illness and health. Racism in obstetrics and gynecology has deep roots in its history. The use of race in clinical decision-making tools, such as those that predict successful vaginal birth after cesarean delivery, should be eliminated. Research that explores the complexities of health disparities and their effects on clinical outcomes are pivotal to race-conscious approaches in medicine.
Moxibustion for COVID-19: A systematic Scoping Review
Authors: Xia Meng , Pang Bo , Yi Shaowei , Shan Xinjue , Deng Shizhe , Qin Yinan , Jiang Tao , Lu Hai
Published: September 2022

Objective:

Moxibustion has been widely used in prevention and treatment of COVID-19. However, there is no systematic review on current topics and clinical findings on moxibustion for COVID-19. We conducted this scoping review to systematically summarize and analyze the themes and findings of published articles, to provide an overview of current knowledge and practice of moxibustion for COVID-19. Methods: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), SinoMed, Wan Fang Data and VIP databases were searched from inception until April 2022. The relevant data were presented through bar graphs, structured tables, and figures along with descriptive statistics and analysis. This coping review was conducted based on the PRISMA-ScR Checklist.

Results:

A total of 76 articles were reviewed: 47 reviews, 19 clinical research studies, 7 systematic reviews (all were protocols), and 3 guidelines. All the studies were conducted by Chinese researchers and published during January 1, 2020 to March 14, 2022. The feasibility of moxibustion in the prevention and treatment of mild or moderate COVID-19 based on the consensus of therapeutic mechanisms and effectiveness. The most adopted approach was observed to be suspended and gentle moxibustion, and the most frequently applied or recommended acupoints were found to be ST36, CV8, CV6, CV4, CV12, GV14, BL13, LI4, ST25, and LR3.

Conclusions:

As a convenient and safe traditional Chinese medicine (TCM) therapy of its own specific feature, moxibustion has been significantly effective at ameliorating mild or moderate symptoms among COVID-19 patients. Further large-scale, well-designed research and international cooperation is still warranted in clinical evaluations of moxibustion.
CHARACTERISTICS OF AGE-RELATED MACULAR DEGENERATION SHOWING A POOR RESPONSE TO THREE LOADING DOSES OF ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR
Authors: Song Yong-Yeon , Jun Ji-Ho , Kim Jung-Tae , Lee Sung-Chul , Lee Min-Woo
Published: September 2022

Purpose:

To analyze the clinical features of refractory age-related macular degeneration patients associated with the response to three consecutive loading doses of anti–vascular endothelial growth factor.

Methods:

A retrospective chart review was performed on typical exudative age-related macular degeneration patients treated by three consecutive anti–vascular endothelial growth factor injections. The patients were divided into a group without residual fluid on optical coherence tomography images (Group 1) and a group with residual fluid (Group 2). We analyzed qualitative and quantitative morphologic features of optical coherence tomography and optical coherence tomography angiography. We performed univariate and multivariate logistic regression analyses to identify factors associated with the treatment response.

Results:

We enrolled a total of 90 patients (Group 1: n = 60, Group 2: n = 30). Under optical coherence tomography, the choroidal thickness differed significantly between groups 1 and 2 (246.60 ± 67.67 vs. 286.90 ± 40.92 µm, P = 0.001). Under optical coherence tomography angiography, the presence of branching (48.3% vs. 73.3%, P = 0.024), loops (31.7% vs. 66.7%, P = 0.002), and a peripheral arcade (40.0% vs. 76.7%, P = 0.001) differed significantly. Logistic regression analysis showed that the initial CT (B = 0.012; P = 0.007), presence of loops (B = 1.289; P = 0.015), and peripheral arcade (B = 1.483; P = 0.008) significantly affected the anti–vascular endothelial growth factor treatment response.

Conclusion:

A thicker choroid and the presence of loops and a peripheral arcade were significantly associated with a poorer response to three loading anti–vascular endothelial growth factor injections in typical exudative age-related macular degeneration patients.
Factors affecting long-term outcome in dorsal root entry zone lesioning for brachial plexus avulsion
Authors: Du Tao , Ji Fan , Ni Bing , Liu Ruicun , Shu Wei , Zhang Xiaohua , Zhu Hongwei , Tao Wei , Hu Yongsheng , Li Yongjie
Published: September 2022

Dorsal root entry zone (DREZ) lesioning is a classical and effective treatment for brachial plexus avulsion (BPA). However, because of a limited number of cases reported in the literature, the factors affecting surgical outcomes are not known. Furthermore, whether this ablative procedure in the spinal level can change the status of phantom limb pain (PLP) and phantom limb sensation (PLS) is unknown. We retrospectively reviewed the patients with preganglionic BPA who underwent DREZ lesioning at a single center. Patients' baseline characteristics and long-term pain and complications were collected. Postoperative changes in PLP and PLS were recorded. Kaplan–Meier analysis was used to evaluate pain-free survival. Multivariate Cox regression analysis was performed to identify factors affecting pain outcomes. A total of 112 patients met the study inclusion criteria. With an average (range) follow-up of 47.4 (10-134) months, the long-term effectiveness and complication rate were 82.1% and 25.9%, respectively. Of 37 patients (33.0%) who developed PLS, 67.6% (25/37) experienced pain relief, whereas in 45.9% (17/37), PLS disappeared or changed after DREZ lesioning. Multivariate analysis showed that patients with shorter pain duration (≤5 years) and PLS had worse pain outcomes. This study revealed factors that predict the pain outcome of DREZ lesioning based on a large series of cases. The diverse postoperative changes in phantom limb indicate that the mechanisms underlying PLS and PLP at the spinal or supraspinal level may vary among patients with BPA. Future studies should investigate the contribution of maladaptive brain plasticity to the outcomes of patients undergoing DREZ lesioning.
Recovery expectations can be assessed with single-item measures: findings of a systematic review and meta-analysis on the role of recovery expectations on return-to-work outcomes after musculoskeletal pain conditions
Authors: Carrière Junie S. , Donayre Pimentel Stephania , Bou Saba Sabine , Boehme Blake , Berbiche Djamal , Coutu Marie-France , Durand Marie-José
Published: September 2022

The objective of this systematic review is to quantify the association between recovery expectations and return-to-work outcomes in adults with musculoskeletal pain conditions. In addition, this review has the second objective to compare the predictive utility of single-item and multi-item recovery expectation scales on return-to-work outcomes. Relevant articles were selected from Embase, PsycINFO, PubMed, Cochrane, and manual searches. Studies that assessed recovery expectations as predictors of return-to-work outcomes in adults with musculoskeletal pain conditions were eligible. Data were extracted on study characteristics, recovery expectations, return-to-work outcomes, and the quantitative association between recovery expectations and return-to-work outcomes. Risk of bias was assessed using the Effective Public Health Practice Project. Odds ratios were pooled to examine the effects of recovery expectations on return-to-work outcomes. Chi-square analyses compared the predictive utility of single-item and multi-item recovery expectation scales on return-to-work outcomes. Thirty studies on a total of 28,741 individuals with musculoskeletal pain conditions were included in this review. The odds of being work disabled at follow-up were twice as high in individuals with low recovery expectations (OR = 2.06 [95% CI 1.20-2.92] P < 0.001). Analyses also revealed no significant differences in the predictive value of validated and nonvalidated single-item measures of recovery expectations on work disability (χ2 = 1.68, P = 0.19). There is strong evidence that recovery expectations are associated with return-to-work outcomes. The results suggest that single-item measures of recovery expectations can validly be used to predict return-to-work outcomes in individuals with musculoskeletal pain conditions.
SARS-CoV-2 Infection Presenting as Acute Chest Syndrome in a Child With Hemoglobin SD-Los Angeles Disease: A Case Report and Review of Literature
Authors: Calderwood Stanley , Sabir Aqsa , Rao Latha , Baker Brian , Balasa Vinod , Sathi Bindu K.
Published: September 2022

Hemoglobin D-Los Angeles is a variant of hemoglobin that can polymerize in the deoxygenated state. When co-inherited with Hemoglobin S (HbSD-Los Angeles disease) a severe sickling syndrome similar to HbSS can result. Corona virus infectious disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome-corona virus-2. It has been associated with acute chest syndrome (ACS) in individuals with sickle cell disease (SCD), but this complication has not previously been reported in patients with HbSD-Los Angeles. Dexamethasone has been shown to improve outcomes in non-SCD patients with severe acute respiratory syndrome-corona virus-2 pneumonia or acute respiratory distress syndrome; however, its use in SCD patients with ACS is controversial due to a reported increased risk of complications including vaso-occlusive painful episodes. Herein, we reported a patient with HbSD-Los Angeles and COVID-19-associated ACS whom we treated with dexamethasone without transfusion. The patient experienced a rapid recovery without sequelae from steroid use.

To further evaluate the use of steroids, we conducted a literature review focusing on the management of pediatric SCD patients with COVID-19-associated ACS. We identified a total of 39 pediatric patients with SCD and COVID-19, of whom 21 (54%) had ACS. Packed red blood cell transfusion (n=11), exchange transfusion (n=4), or a combination of exchange transfusion and packed red blood cell transfusion (n=4) were the most frequently reported treatment, with hydroxychloroquine (n=5), remdesivir (n=1), and tocilizumab (n=1) also being reported. Three patients were treated with dexamethasone. All patients recovered and no adverse outcomes from steroid use were reported. Even though transfusion is considered the standard of care for children with ACS and steroids are not routinely recommended, our experience suggested that COVID-19-associated ACS may be an important exception, especially for patients who refuse transfusion or are in resource-poor nations where blood transfusions may not be readily available. Further studies are warranted to confirm these observations.
c-Met Signaling as a Therapeutic Target in Head and Neck Cancer
Authors: Centuori Sara M. , Bauman Julie E.
Published: September 2022

Despite a dearth of activating driver mutations in head and neck squamous cell carcinoma (HNSCC), aberrant activation of the oncogenes, epidermal growth factor receptor (EGFR), and c-Met is near-universal in human papillomavirus (HPV)–negative disease. Although EGFR activation drove the successful development of the anti-EGFR monoclonal antibody cetuximab in HNSCC, no c-Met–targeting therapy has gained regulatory approval. Inhibition of the c-Met pathway may subvert oncogenesis within the tumor-intrinsic compartment, blocking tumoral proliferation, invasion, migration, and metastasis, or the tumor-extrinsic compartment, modulating the immunosuppressive tumor microenvironment. This review discusses the rationale and current drug development strategies for targeting c-Met or its exclusive ligand hepatocyte growth factor (HGF) in HNSCC.
Individual differences in CD4/CD8 T-cell ratio trajectories and associated risk profiles modeled from acute HIV infection
Authors: Paul Robert , Cho Kyu , Bolzenius Jacob , Sacdalan Carlo , Ndhlovu Lishomwa C. , Trautmann Lydie , Krebs Shelly , Tipsuk Somporn , Crowell Trevor A. , Suttichom Duanghathai , Colby Donn J. , Premeaux Thomas A. , Phanuphak Nittaya , Chan Phillip , Kroon Eugène , Vasan Sandhya , Hsu Denise , Carrico Adam , Valcour Victor , Ananworanich Jintanat , Robb Merlin L. , Ake Julie A. , Sriplienchan Somchai , Spudich Serena
Published: September 2022

Objective

We examined individual differences in CD4/CD8 T-cell ratio trajectories and associated risk profiles from acute HIV infection (AHI) through 144 weeks of antiretroviral therapy (ART) using a data-driven approach.

Methods

483 AHI participants began ART during Fiebig I-V and completed follow-up evaluations for 144 weeks. CD4+, CD8+, and CD4/CD8 T-cell ratio trajectories were defined followed by analyses to identify associated risk variables.

Results

Participants had a median viral load (VL) of 5.88 copies/mL and CD4/CD8 T-cell ratio of .71 at enrollment. After 144 weeks of ART, the median CD4/CD8 T-cell ratio was 1.3. Longitudinal models revealed five CD4/CD8 T-cell ratio subgroups: group 1 (3%) exhibited a ratio > 1.0 at all visits; groups 2 (18%) and 3 (29%) exhibited inversion at enrollment, with normalization 4 and 12 weeks after ART, respectively; and groups 4 (31%) and 5 (18%) experienced CD4/CD8 T-cell ratio inversion due to slow CD4+ T-cell recovery (group 4) or high CD8+ T-cell count (group 5). Persistent inversion corresponded to ART onset after Fiebig II, higher VL, soluble CD27 and TIM-3, and lower eosinophil count. Individuals with slow CD4+ T-cell recovery exhibited higher VL, lower white blood cell count, lower basophil percent and treatment with standard ART, as well as worse mental health and cognition, compared to individuals with high CD8+ T-cell count.

Conclusions

Early HIV disease dynamics predict unfavorable CD4/CD8 T-cell ratio outcomes after ART. CD4+ and CD8+ T-cell trajectories contribute to inversion risk and correspond to specific viral, immune, and psychological profiles during AHI. Adjunctive strategies to achieve immune normalization merit consideration.
The Association of Social Connectivity and Body Weight With the Onset of Type 2 Diabetes: Findings From the Population-Based Prospective MONICA/KORA Cohort
Authors: Atasoy Seryan , Johar Hamimatunnisa , Kruse Johannes , Lukaschek Karoline , Peters Annette , Ladwig Karl-Heinz
Published: September 2022

Objective

Low levels of social connectivity are related to the onset of type 2 diabetes mellitus (T2D), and this study investigates the role of body weight in this association.

Methods

In a sample of 9448 participants followed for a mean of 15.3 years (186,158.5 person-years) from the Monitoring of Trends and Determinants in Cardiovascular Disease Augsburg/Cooperative Health Research in the Region of Augsburg population-based cohort conducted in Germany, we investigated the association of social connectivity, measured by the Social Network Index, and body mass index (BMI) with the risk of clinically validated T2D incidence using stratified Cox proportional hazards regression models adjusted for sociodemographic, life-style, cardiometabolic, and psychosocial risk factors.

Results

During a mean follow-up of 14.1 years (186,158.5 person-years), 975 (10.3%) participants developed T2D. Participants with low social connectivity developed T2D at a higher rate than socially connected participants (10.0 versus 8.0 cases/10,000 person-years); however, BMI played a significant role in the association of social connectivity with T2D (p < .001). In comparison to their socially connected counterparts, low social connectivity was associated with a higher rate of T2D incidence in normal-weight (6.0 versus 2.0 cases/10,000 person-years), but not overweight (13.0 versus 13.0 cases/10,000 person-years) or obese participants (32.0 versus 30.0 cases/10,000 person-years). Correspondingly, Cox regression analysis showed that 5-unit increments in BMI increased the risk of T2D in socially connected participants (hazard ratio = 3.03, 95% confidence interval = 2.48–3.79, p < .001) at a substantially higher rate than in low socially connected participants (hazard ratio = 1.77, 95% confidence interval = 1.45–2.16, p < .001).

Conclusion

The detrimental link between low social connectivity and increased risk of T2D is substantially stronger in participants with a lower BMI.