bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 19175: Anaphylaxis After Alteplase During Treatment of Pulmonary Embolism
Authors: Enstrom Cate , Roberts Austin , Gast Sarah , Moore Catherine , Cavanaugh Sharp Angel , Garcia Brianna , Bock Ashley , Gage Ann
Published: November 2023

Introduction:
Anaphylaxis is a rare complication to alteplase, a recombinant tissue plasminogen activator (tPA), during administration for pulmonary embolism (PE).

Case Presentation:
A 72-year-old male with a history of necrotizing fasciitis, recent below the knee amputation, and concern for metastatic melanoma had been undergoing treatment for an acute DVT with apixaban when he presented with an extensive saddle pulmonary embolism. He was evaluated by a Pulmonary Embolism Response Team (PERT) and classified as high risk (sPESI 2, new right ventricular dysfunction, and hypoxemia) and treated with 50 mg alteplase over two hours. At the end of his infusion, he experienced worsening hypoxemia and sudden hypotension treated with fluid resuscitation and an epinephrine infusion. Hemodynamic instability was thought to be secondary to obstructive shock so an additional 50 mg of alteplase was ordered. After the initial bolus of 10 mg alteplase, the patient demonstrated signs of anaphylaxis. He was initially treated with epinephrine, diphenhydramine, famotidine, methylprednisolone, and lactated ringers for the anaphylactic shock. The patient eventually required the addition of norepinephrine, vasopressin, and methylene blue for resolution of the shock. No additional alteplase was administered and a heparin infusion was resumed for treatment of the pulmonary embolism. He was ultimately successfully weaned off vasopressors and oxygen support with resolution of the pulmonary embolism.

Discussion:
Cardiac critical care providers should monitor for signs of anaphylaxis when using tPA in the management of PE. The main intervention of anaphylactic shock is administration of epinephrine. Updated guidelines recommend use of intramuscular epinephrine in the setting of anaphylaxis.
Abstract 19192: Deciphering the Cardioprotective Role of Ufm1 Modification in Cardiac Remodeling
Authors: Tandra Varsha
Published: November 2023

UFM1 (ubiquitin-fold modifier 1) is a novel Ub-like protein that covalently modifies protein substrates via a highly conserved E1 (UBA5)-E2 (UFC1)-E3 (UFL1) enzymatic cascade. UFM1 modification (ufmylation) controls multiple pathophysiological events and is implicated in various human diseases. However, the significance of ufmylation in cardiac health remains poorly understood. We have previously reported that ufmylation is upregulated in compensated, hypertrophic mouse hearts but decreased in failing human hearts. Inhibition of ufmylation by targeted ablation of the E3 UFM1 ligase 1 (UFL1) in mouse hearts resulted in dilated cardiomyopathy under baseline and stress conditions. Targeted deletion of a putative UFM1 target, UFBP1, also evokes endoplasmic reticulum (ER) stress, leading to dilated cardiomyopathy While these exciting data reveal the pivotal role of ufmylation in the maintenance of ER/cardiac homeostasis, it remains unclear whether ufmylation of cardiac proteins is required for heart function and if so, how ufmylation regulates cardiac function. To determine the role of UFM1 modification in cardiomyocytes we have generated cardiac specific UFM1 CKO mice. The UFM1 CKO mice developed dilated cardiomyopathy at resting condition, as indicated by left ventricle (LV) wall thinning, chamber dilatation and impaired contractility at 4 months of age, which were further exacerbated by 6 months. To test the hypothesis that UFM1 protects the heart by modifying cardiac proteins we replenished UFM1-deficient mice with WT and conjugation deficient UFM1 via AAV9. Restoration of WT-UFM1 expression, but not the conjugation-deficient mutant, attenuated cardiac dysfunction of UFM1CKO hearts. It appears that UFM1 modification constraints pathological cardiac remodeling by maintaining ER homeostasis. Taken together, our data show that Ufmylation is a critical post-translational modification that regulates cardiac homeostasis.
Abstract 19197: Cardiopulmonary Outcomes and Disparities in Long-Term Anticoagulant Use in Secondary Pulmonary Hypertension Patients: A Nationwide Analysis
Authors: Shankar Kavya , Ahmed Ibrahim
Published: November 2023

Introduction:
The use of anti-coagulation in pulmonary hypertension patients has shown to improve mortality. Our aim was to characterize patient demographics, analyze disparities and investigate the effect of long-term anti-coagulant (AC) use on outcomes in secondary pulmonary hypertension (PAH) patients.

Methods:
This was a retrospective cohort study using the 2019 Nationwide Inpatient Sample database to identify admissions in adults with diagnoses of secondary PAH and long-term AC use. Multivariate linear and logistic regression models were adjusted for demographic variables and comorbid conditions. Primary outcome was all-cause mortality, and secondary outcomes were outcomes of long-term AC use in secondary PAH patients and length of stay (LOS).

Results:
Out of 1,141,870 secondary PAH patients, 287,940 had long-term AC use. The AC-PAH cohort when compared to the Non-AC-PAH cohort had lower in-hospital mortality (3.35% vs 5.18%, p<0.001) and shorter LOS (6.04 days vs 7.03 days, p<0.001). The AC-PAH cohort had older patients (mean age 74.46 vs 69.55 years, p<0.001), more White patients (73.10% vs 64.76%, p<0.001) and fewer Black patients (15.62% vs 20.10%, p<0.001). The AC-PAH cohort when compared to the Non-AC-PAH cohort had lower odds of pulmonary embolism (PE)(OR 0.92, 95% CI 0.86-0.98, P<0.05), acute respiratory failure (RF)(OR 0.73, 95% CI 0.71-0.75, p<0.001), ventilator dependence (OR 0.46, 95% CI 0.38-0.55, p<0.001), systemic HTN (OR 0.91, 95% CI 0.83-0.99, p<0.05), cardiac arrest (OR 0.65, 95% CI 0.59-0.72, p<0.001), ischemic cardiomyopathy (OR 0.94, 95% CI 0.90-0.98, p<0.005), STEMI (OR 0.31, 95% CI 0.22-0.42, p<0.001), NSTEMI (OR 0.52, 95% CI 0.49-0.55, p<0.001) and acute ischemic stroke (OR 0.71, 95% CI 0.66-0.77, p<0.001). The AC-PAH cohort had higher odds of chronic RF (OR 1.07, 95% CI 1.02-1.12, P<0.005) and atrial fibrillation (A.Fib)(OR 2.79, 95% CI 2.72-2.86, p<0.001).

Conclusion
In secondary PAH patients, the long-term use of AC was associated with lower in-hospital mortality, shorter LOS and lower odds of having PE, acute RF, ventilator dependence, systemic HTN, ischemic cardiomyopathy, STEMI, NSTEMI and acute ischemic stroke. More extensive research is required in this area to investigate outcomes further.
Economic Modeling Analysis of an Intensive GDMT Optimization Program in Hospitalized Heart Failure Patients
Authors: Dixit Neal M. , Parikh Neil U. , Ziaeian Boback , Fonarow Gregg C.
Published: November 2023

BACKGROUND:

The STRONG-HF trial (Safety, Tolerability and Efficacy of Up-Titration of Guideline-Directed Medical Therapies for Acute Heart Failure) demonstrated substantial reductions in the composite of mortality and morbidity over 6 months among hospitalized patients with heart failure (HF) who were randomized to intensive guideline-directed medical therapy (GDMT) optimization compared with usual care. Whether an intensive GDMT optimization program would be cost-effective for patients with HF with reduced ejection fraction is unknown.

METHODS:

Using a 2-state Markov model, we evaluated the effect of an intensive GDMT optimization program on hospitalized patients with HF with reduced ejection fraction. Two population models were created to simulate this intervention, a clinical trial model, based on the participants in the STRONG-HF trial, and a real-world model, based on the Get With The Guidelines–HF registry of patients admitted with worsening HF. We then modeled the effect of a 6-month intensive triple therapy GDMT optimization program comprised of cardiologists, clinical pharmacists, and registered nurses. Hazard ratios from the intervention arm of the STRONG-HF trial were applied to both population models to simulate clinical and financial outcomes of an intensive GDMT optimization program from a US health care sector perspective with a lifetime time horizon. Optimal quadruple GDMT use was also modeled.

RESULTS:

An intensive GDMT optimization program was extremely cost-effective with incremental cost-effectiveness ratios <$10 000 per quality-adjusted life-year in both models. Optimal quadruple GDMT implementation resulted in the most gains in life-years with incremental cost-effectiveness ratios of $60 000 and $54 000 in the clinical trial and real-world models, respectively.

CONCLUSIONS:

An intensive GDMT optimization program for patients hospitalized with HF with reduced ejection fraction would be cost-effective and result in substantial gains in clinical outcomes, especially with the use of optimal quadruple GDMT. Clinicians, payers, and policymakers should prioritize the creation of such programs.
Meta-Analysis of Penetrance and Systematic Review on Transition to Disease in Genetic Hypertrophic Cardiomyopathy
Authors: Topriceanu Constantin-Cristian , Pereira Alexandre C. , Moon James C. , Captur Gabriella , Ho Carolyn Y.
Published: November 2023

BACKGROUND:

Hypertrophic cardiomyopathy (HCM) is characterized by unexplained left ventricular hypertrophy and is classically caused by pathogenic or likely pathogenic variants (P/LP) in genes encoding sarcomere proteins. Not all subclinical variant carriers will manifest clinically overt disease because penetrance (proportion of sarcomere or sarcomere-related P/LP variant carriers who develop disease) is variable, age dependent, and not reliably predicted.

METHODS:

A systematic search of the literature was performed. We used random-effects generalized linear mixed model meta-analyses to contrast the cross-sectional prevalence and penetrance of sarcomere or sarcomere-related genes in 2 different contexts: clinically-based studies on patients and families with HCM versus population or community-based studies. Longitudinal family/clinical studies were additionally analyzed to investigate the rate of phenotypic conversion from subclinical to overt HCM during follow-up.

RESULTS:

In total, 455 full-text manuscripts and articles were assessed. In family/clinical studies, the prevalence of sarcomere variants in patients diagnosed with HCM was 34%. The penetrance across all genes in nonproband relatives carrying P/LP variants identified during cascade screening was 57% (95% CI, 52%–63%), and the mean age at HCM diagnosis was 38 years (95% CI, 36%–40%). Penetrance varied from ≈32% for
MYL3
(myosin light chain 3) to ≈55% for
MYBPC3
(myosin-binding protein C3), ≈60% for
TNNT2
(troponin T2) and
TNNI3
(troponin I3), and ≈65% for
MYH7
(myosin heavy chain 7). Population-based genetic studies demonstrate that P/LP sarcomere variants are present in the background population but at a low prevalence of <1%. The penetrance of HCM in incidentally identified P/LP variant carriers was also substantially lower at ≈11%, ranging from 0% in Atherosclerosis Risk in Communities to 18% in UK Biobank. In longitudinal family studies, the pooled phenotypic conversion across all genes was 15% over an average of ≈8 years of follow-up, starting from a mean of ≈16 years of age. However, short-term gene-specific phenotypic conversion varied between ≈12% for
MYBPC3
and ≈23% for
MYH7
.

CONCLUSIONS:

The penetrance of P/LP variants is highly variable and influenced by currently undefined and context-dependent genetic and environmental factors. Additional longitudinal studies are needed to improve our understanding of true lifetime penetrance in families and in the community and to identify drivers of the transition from subclinical to overt HCM.
Inflammation and Cholesterol as Predictors of Cardiovascular Events Among 13 970 Contemporary High-Risk Patients With Statin Intolerance
Authors: Ridker Paul M , Lei Lei , Louie Michael J. , Haddad Tariq , Nicholls Stephen J. , Lincoff A. Michael , Libby Peter , Nissen Steven E. ,   on behalf of the CLEAR Outcomes Investigators
Published: November 2023

BACKGROUND:

Among patients treated with statin therapy to guideline-recommended cholesterol levels, residual inflammatory risk assessed by high-sensitivity C-reactive protein (hsCRP) is at least as strong a predictor of future cardiovascular events as is residual risk assessed by low-density lipoprotein cholesterol (LDLC). Whether these relationships are present among statin-intolerant patients with higher LDLC levels is uncertain but has implications for the choice of preventive therapies, including bempedoic acid, an agent that reduces both LDLC and hsCRP.

METHODS:

The multinational CLEAR-Outcomes trial (Cholesterol Lowering via Bempedoic Acid, an ACL-Inhibiting Regimen Outcomes Trial) randomly allocated 13 970 statin-intolerant patients to 180 mg of oral bempedoic acid daily or matching placebo and followed them for a 4-component composite of incident myocardial infarction, stroke, coronary revascularization, or cardiovascular death, and for all-cause mortality. Quartiles of increasing baseline hsCRP and LDLC were assessed as predictors of future adverse events after adjustment for traditional risk factors and randomized treatment assignment.

RESULTS:

Compared with placebo, bempedoic acid reduced median hsCRP by 21.6% and mean LDLC levels by 21.1% at 6 months. Baseline hsCRP was significantly associated with the primary composite end point of major cardiovascular events (highest versus lowest hsCRP quartile; hazard ratio [HR], 1.43 [95% CI, 1.24–1.65]), cardiovascular mortality (HR, 2.00 [95% CI, 1.53–2.61]), and all-cause mortality (HR, 2.21 [95% CI, 1.79–2.73]). By contrast, the relationship of baseline LDLC quartile (highest versus lowest) to future events was smaller in magnitude for the primary composite cardiovascular end point (HR, 1.19 [95% CI, 1.04–1.37]) and neutral for cardiovascular mortality (HR, 0.90 [95% CI, 0.70–1.17]) and all-cause mortality (HR, 0.95 [95% CI, 0.78–1.16]). Risks were high for those with elevated hsCRP irrespective of LDLC level. Bempedoic acid demonstrated similar efficacy in reducing cardiovascular events across all levels of hsCRP and LDLC.

CONCLUSIONS:

Among contemporary statin-intolerant patients, inflammation assessed by hsCRP predicted risk for future cardiovascular events and death more strongly than hyperlipidemia assessed by LDLC. Compared with placebo, bempedoic acid had similar efficacy for reducing cardiovascular risk across hsCRP and LDLC strata.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02993406.
Prognostic Utility of Cardiovascular Magnetic Resonance–Based Phenotyping in Patients With Muscular Dystrophy
Authors: Kashyap Niharika , Nikhanj Anish , Labib Dina , Prosia Easter , Rivest Sandra , Flewitt Jacqueline , Pfeffer Gerald , Bakal Jeffrey A. , Siddiqi Zaeem A. , Coulden Richard A. , Thompson Richard , White James A. , Oudit Gavin Y.
Published: November 2023

Background

The prognostic utility of cardiovascular magnetic resonance imaging, including strain analysis and tissue characterization, has not been comprehensively investigated in adult patients with muscular dystrophy.

Methods and Results

We prospectively enrolled 148 patients with dystrophinopathies (including heterozygotes), limb‐girdle muscular dystrophy, and type 1 myotonic dystrophy (median age, 36.0 [interquartile range, 23.0–50.0] years; 51 [34.5%] women) over 7.7 years in addition to an age‐ and sex–matched healthy control cohort (n=50). Cardiovascular magnetic resonance markers, including 3‐dimensional strain and fibrosis, were assessed for their respective association with major adverse cardiac events. Our results showed that markers of contractile performance were reduced across all muscular dystrophy groups. In particular, the dystrophinopathies cohort experienced reduced left ventricular (LV) ejection fraction and high burden of replacement fibrosis. Patients with type 1 myotonic dystrophy showed a 26.8% relative reduction in LV mass with corresponding reduction in chamber volumes. Eighty‐two major adverse cardiac events occurred over a median follow‐up of 5.2 years. Although LV ejection fraction was significantly associated with major adverse cardiac events (adjusted hazard ratio [aHR], 3.0 [95% CI, 1.4–6.4]) after adjusting for covariates, peak 3‐dimensional strain amplitude demonstrated greater predictive value (minimum principal amplitude: aHR, 5.5 [95% CI, 2.5–11.9]; maximum principal amplitude: aHR, 3.3 [95% CI, 1.6–6.8]; circumferential amplitude: aHR, 3.4 [95% CI, 1.6–7.2]; longitudinal amplitude: aHR, 3.4 [95% CI, 1.7–6.9]; and radial strain amplitude: aHR, 3.0 [95% CI, 1.4–6.1]). Minimum principal strain yielded incremental prognostic value beyond LV ejection fraction for association with major adverse cardiac events (change in
χ
2
=13.8;
P
<0.001).

Conclusions

Cardiac dysfunction is observed across all muscular dystrophy subtypes; however, the subtypes demonstrate distinct phenotypic profiles. Myocardial deformation analysis highlights unique markers of principal strain that improve risk assessment over other strain markers, LV ejection fraction, and late gadolinium enhancement in this vulnerable patient population.
Associations of Cerebrovascular Regulation and Arterial Stiffness With Cerebral Small Vessel Disease: A Systematic Review and Meta‐Analysis
Authors: Scheuermann Britton C. , Parr Shannon K. , Schulze Kiana M. , Kunkel Olivia N. , Turpin Vanessa‐Rose G. , Liang Jia , Ade Carl J.
Published: November 2023

Background

Cerebral small vessel disease (cSVD) is a major contributing factor to ischemic stroke and dementia. However, the vascular pathologies of cSVD remain inconclusive. The aim of this systematic review and meta‐analysis was to characterize the associations between cSVD and cerebrovascular reactivity (CVR), cerebral autoregulation, and arterial stiffness (AS).

Methods and Results

MEDLINE, Web of Science, and Embase were searched from inception to September 2023 for studies reporting CVR, cerebral autoregulation, or AS in relation to radiological markers of cSVD. Data were extracted in predefined tables, reviewed, and meta‐analyses performed using inverse‐variance random effects models to determine pooled odds ratios (ORs). A total of 1611 studies were identified; 142 were included in the systematic review, of which 60 had data available for meta‐analyses. Systematic review revealed that CVR, cerebral autoregulation, and AS were consistently associated with cSVD (80.4%, 78.6%, and 85.4% of studies, respectively). Meta‐analysis in 7 studies (536 participants, 32.9% women) revealed a borderline association between impaired CVR and cSVD (OR, 2.26 [95% CI, 0.99–5.14];
P
=0.05). In 37 studies (27 952 participants, 53.0% women) increased AS, per SD, was associated with cSVD (OR, 1.24 [95% CI, 1.15–1.33];
P
<0.01). Meta‐regression adjusted for comorbidities accounted for one‐third of the AS model variance (
R
2
=29.4%,
P
moderators
=0.02). Subgroup analysis of AS studies demonstrated an association with white matter hyperintensities (OR, 1.42 [95% CI, 1.18–1.70];
P
<0.01).

Conclusions

The collective findings of the present systematic review and meta‐analyses suggest an association between cSVD and impaired CVR and elevated AS. However, longitudinal investigations into vascular stiffness and regulatory function as possible risk factors for cSVD remain warranted.
Sociodemographic Factors and the Risk of Pediatric Out‐of‐Hospital Cardiac Arrest in Ontario, Canada: A Province‐Wide Case–Control Study
Authors: Idrees Samina , Anderson Kelly K. , Choi Yun‐Hee , Tijssen Janice A.
Published: November 2023

Background

Pediatric out‐of‐hospital cardiac arrest (POHCA) is associated with significant mortality and poor neurological outcomes. We aimed to describe the association between sociodemographic factors and POHCA risk in Ontario, Canada.

Methods and Results

We conducted a province‐wide case–control study at ICES, where patient records are linked across administrative databases. The case group included children (aged 1 day to 17 years) who experienced an out‐of‐hospital cardiac arrest between 2004 and 2020. Controls were matched up to 1:4 on age, sex, index date, and key comorbidities. We used conditional logistic regression to measure the association between sociodemographic indicators and POHCA risk. The case and control groups included 1826 and 7254 children, respectively. Children living in areas with the highest levels of material deprivation (adjusted odds ratio [aOR], 2.35 [95% CI, 1.94–2.85]) and dependency (aOR, 1.22 [95% CI, 1.01–1.48]) had a higher odds of POHCA, relative to children living in regions with the lowest levels of material deprivation and dependency, respectively. Children living in neighborhoods with the lowest levels of ethnic diversity had a higher odds of POHCA (aOR, 1.62 [95% CI, 1.30–2.01]), relative to children living in neighborhoods with the highest levels of ethnic diversity. The odds of POHCA were lower in immigrants (aOR, 0.67 [95% CI, 0.47–0.95]), relative to the general population. Northern urban residence was associated with a higher odds of POHCA (aOR, 1.45 [95% CI, 1.13–1.87]), relative to southern urban residence.

Conclusions

Children living in neighborhoods with high levels of marginalization may have an elevated risk of experiencing POHCA. These findings highlight the importance of addressing disparities through targeted prevention and intervention efforts.
Fabaceae Lindl. in the Chapada do Araripe, Northeast Brazil
Authors: CRUZ MARIANA FERREIRA DA , SANTOS ANTONIO CARLITO BEZERRA DOS , SANTOS MARCOS AURÉLIO FIGUEIREDO DOS , NETO RAIMUNDO LUCIANO SOARES , LACERDA SÍRLEIS RODRIGUES , NASCIMENTO MÁRCIO PEREIRA DO , LOIOLA MARIA IRACEMA BEZERRA , SILVA MARIA ARLENE PESSOA DA
Published: November 2023

The Brazilian plateau known as Chapada do Araripe is home to several types of vegetation and a diversity of native species. This plateau is located among the Brazilian states of Ceará, Pernambuco, and Piauí, in the Northeast region. This study consisted of a floristic inventory of Fabaceae species prevailing in different environments of the mentioned plateau. Monthly botanical expeditions were performed from October 2021 to November 2022; these occurred at previously selected sites. The plant collection, herborization, and identification of the species were carried out according to the specialized literature, and the specimens were deposited in the Herbário Caririense Dárdano de Andrade-Lima (HCDAL). A total of 194 species, 11 infraspecific taxa, and 81 genera belonging to five subfamilies were listed. These numbers represented approximately 32% of the diversity of Fabaceae recorded in Brazil, and an increase of approximately 115% in the number of species previously recorded in the Chapada do Araripe. The most diverse subfamilies were Caesalpinioideae and Papilionoideae, with 90 and 89 species, respectively. The most representative genera were Senna (19 spp.), Chamaecrista (15 spp.), and Mimosa (14 spp.). Thirteen species and three varieties were new records in Ceará state. The predominant growth habit was tree type, recorded in 44% of the species (86), and the main habitats were Steppe Savannah, Savannah, and Wooded Steppe Savannah. Thirteen species are endemic to the Caatinga phytogeographic domain: Copaifera arenicola, Copaifera cearensis, Hymenaea cangaceira, Cenostigma microphyllum, Mimosa caesalpiniifolia, Mimosa misera, Parapiptadenia zehntneri, Pithecellobium diversifolium, Senna cearensis, Senna gardneri, Senna lechriosperma, Crotalaria holosericea e Luetzelburgia bahiensis. Regarding the status of species protection and conservation, most are in Least Concern status (48.8%), four are Near Threatened (Hymenaea cangaceira, Pterogyne nitens, Dalbergia cearensis, Parapiptadenia zehntneri), two species are in Vulnerable status (Melanoxylon brauna and Senegalia cearensis), one species did not have enough data for assessment (Copaifera cearensis), and one is Endangered (Amburana cearensis). The findings of the present study can support conservation strategies, and ecological and phytosociological studies, among others. Also, it can be used for planning and promoting environmental education. Such information is valuable for the conservation of biodiversity and sustainable management of natural resources of the Chapada do Araripe.
Two new species and two new records for cicadas (Hemiptera: Cicadidae) from French Guiana, with an updated faunal list of French Guiana and the first synoptic list for Guyana
Authors: SANBORN ALLEN F.
Published: November 2023

Zammara conflutrimacula n. sp. and Fidicinoides ininiensis n. sp. are described as new. The first records of Guyalna polypaga Sanborn, 2019 and Taphura dolabella Sanborn, 2017 are reported for French Guiana. Cicada clarisona Hancock, 1834 nomen nudum, revised status, is shown to be unavailable. The first synoptic list of cicadas for Guyana is provided. The currently known cicada fauna for French Guiana is 73 species, 20 genera, five tribes, and three subfamilies. The known fauna of Guyana is 12 species, nine genera, two tribes and one subfamily.
Non-Operative Approach to Contained Perforated Marginal Ulcers: A Systematic Review and Case Series
Authors: Pope Rand , English Wayne , Walden Rachel L. , Bradley Emma , Spann Matthew , Ardila-Gatas Jessica , Broucek Joseph , Williams Brandon , Samuels Jason M.
Published: November 2023

Background

Perforated marginal ulcers (PMUs) are a rare but known complication of bariatric surgery. Management typically involves prompt surgical intervention, but limited data exists on non-operative approaches. This study reviews published data on non-operative management of PMUs and presents a case series of patients who were managed non-operatively. Our hypothesis is that certain patients with signs of perforation can be successfully managed non-operatively with close observation.

Methods

We completed a systematic review searching PubMed, Embase, Web of Science, Cochrane, and clinicaltrials.gov. Ultimately 3 studies described the presentation and non-operative management of 5 patients. Additionally, we prospectively collected data from our institution on all patients who presented between Dec. 2022 and Dec. 2023 with PMUs confirmed on imaging and managed non-operatively.

Results

In our literature review, three patients had Roux-en-Y gastric bypass (RYGB), while two had one anastomosis gastric bypass. One patient required surgery two days after admission. Another underwent elective conversion surgery weeks later for a non-healing ulcer. Two received endoscopic interventions. One patient recovered with nil-per-os (NPO) status, and intravenous proton pump inhibitor (PPI) treatment. The patients in our case series presented with normal vital signs, an average of 30 months after RYGB, and with CT scan signs of perforation. None of these patients required surgical or endoscopic intervention.

Conclusion

In conclusion, while perforated marginal ulcers have traditionally been considered a surgical emergency, some patients can be successfully treated with non-operative management. More research is needed to identify the clinical presentation features, comorbidities, and imaging findings of this group.
Mitigating Infection Risk in Upper Airway Stimulation
Authors: Ali Naushin S. , Fitzpatrick IV Thomas H. , Islam Albina S. , Nord Ryan S.
Published: November 2023

Objective:

This study aims to define the incidence of infection with upper airway stimulation (UAS) devices requiring explantation in a single academic center and identify factors that may influence the risk of infection.

Methods:

A database of patients who underwent UAS at a single tertiary referral academic center from 2017 to 2021 was retrospectively reviewed to identify patients who developed surgical site infections, with and without subsequent explantation. Additional data for cases complicated by infection was extracted from the electronic medical record (EMR) and included: demographic information, medical history, complications and management, and overall outcomes. In March 2021, 2 modifications to infection control protocols were implemented: double skin preparation with Betadine and chlorhexidine, and MRSA decolonization. Statistical analysis was performed to compare infectious risk before and after these protocol changes.

Results:

In the study period, 215 patients underwent UAS in the specified time period and 3 cases (1.4%) of postoperative infections were identified, all of which required explantation. The infection rate did not significantly change after modifications to the surgical prep protocol ( P = .52).

Conclusions:

While no significant difference in infection risk was noted after modifying infection control protocols, additional longer-term study is warranted to elucidate effective infection reduction strategies.
Role of Lymphovascular Invasion in Oral Cavity Squamous Cell Carcinoma Regional Metastasis and Prognosis
Authors: Moore Abigail E. , Alvi Sameer A. , Tarabichi Osama , Zhu Vivian L. , Buchakjian Marisa R.
Published: November 2023

Objective:

The overall 5-year survival for oral squamous cell carcinoma (OSCC) has not changed in the last 20 years despite advances in treatment. Lymphovascular invasion (LVI) has been shown to be a negative prognostic factor in other cancers, however its role in the prognosis of OSCC remains unclear. This study aims to determine if LVI is a predictor of cervical lymph node metastasis and/or recurrence in OSCC.

Methods:

We conducted a retrospective cohort review of patients from our institutional cancer registry who were treated for OSCC between 2004 and 2018. Patient demographics, surgical pathology results, and clinical outcome data were collected. A multivariable logistic regression analysis was performed to determine if LVI was an independent predictor of cervical lymph node metastasis and/or recurrence.

Results:

442 patients were included, 32.8% were female and median age at time of diagnosis was 61.2 years. LVI was present in 32.8% of patients. When controlled for age, sex, t-classification, perineural invasion, depth of invasion (DOI), and margin status, LVI was a significant predictor of the presence of cervical node metastasis (OR: 3.42, CI: 2.17-5.39, P < .001). There was no significant association found between LVI and local recurrence (OR: 1.03, CI: 0.57-1.84, P = .92), regional recurrence (OR: 1.10, CI: 0.57-2.11, P = .78), or distant recurrence (OR: 1.59, CI: 0.87-2.94, P = .13).

Conclusion:

The results of this study suggest that LVI is a significant predictor of the presence of cervical lymph node metastasis at presentation independent of other known prognostic factors. LVI, however, was not found to be a significant independent predictor of locoregional or distant recurrence. Level of Evidence: Level III
Alternative metrics for characterizing longer-term clinical outcomes in difficult-to-treat depression: II. Sensitivity to treatment effects
Authors: Aaronson Scott T , Sackeim Harold A , Jiang Mei , Badejo Sarah , Greco Teresa , Bunker Mark T , Conway Charles R , Demyttenaere Koen , Young Allan H , McAllister-Williams R Hamish , Rush A John
Published: November 2023

Objective:

Characteristics of difficult-to-treat depression (DTD), including infrequent symptom remission and poor durability of benefit, compel reconsideration of the outcome metrics historically used to gauge the effectiveness of antidepressant interventions.

Methods:

Self-report and clinician assessments of depression symptom severity were obtained regularly over a 2-year period in a difficult-to-treat depression registry sample receiving treatment as usual (TAU), with or without vagus nerve stimulation (VNS). Alternative outcome metrics for characterizing symptom change were compared in effect size and discriminating power in distinguishing the vagus nerve stimulation + treatment as usual and treatment as usual treatment groups. We expected metrics based on remission status to produce weaker between-group separation than those based on the classifications of partial response or response and metrics that integrate information over time to produce greater separation than those based on single endpoint assessment.

Results:

Metrics based on remission status had smaller effect size and poorer discrimination in separating the treatment groups than metrics based on partial response or response classifications. Metrics that integrated information over the 2-year observation period had stronger performance characteristics than those based on symptom scores at single endpoint assessment. For both the clinician-rated and self-report depression ratings, the metrics with the strongest performance characteristics were the median percentage change in symptom scores over the observation period and the proportion of the observation period in partial response or better.

Conclusion:

In difficult-to-treat depression, integrative symptom severity-based and time-based measures are sensitive and informative outcomes for assessing between-group treatment effects, while metrics based on remission status are not.
Book review: Rajan Kumar, Meeta Keswani Mehra, G. Venkat Raman and Meenakshi Sundriyal (eds.), Locating BRICS in the Global Order: Perspectives from the Global South
Authors: Subba Bhim B.
Published: November 2023

Rajan Kumar, Meeta Keswani Mehra, G. Venkat Raman and Meenakshi Sundriyal (eds.), Locating BRICS in the Global Order: Perspectives from the Global South (London and New York: Routledge, 2023), pp. xix + 337, £39.99. ISBN 9780367708085 (Paperback).
Biased Bullying Victimization and Student Wellbeing: Evidence From a Coarsened Exact Matching Analysis
Authors: Kurpiel Allison
Published: November 2023

This study tested whether bias motivation is an aggravating element of bullying victimization, such that victims of bullying involving bias experience lower wellbeing than victims of nonbiased bullying and nonvictims. Using nationally representative data from the 2009/2010 United States Health Behavior in School-aged Children (HBSC) survey ( n = 11,335), I use coarsened exact matching (CEM) to compare wellbeing for youth in exposure and control groups who are similar on the measured covariates. Results reveal that biased bullying is positively associated with unwellness, implying that greater research and policy attention to this form of bullying is warranted.
Contextualizing Evaluation of Performance in Volleyball: Introducing Contextual Individual Contribution Coefficients to Assess Technical Actions
Authors: López-Serrano Carlos , Zakynthinaki María , Mon-López Daniel , Molina Martín Juan José
Published: November 2023

In this study, we proposed novel metrics for evaluating volleyball technical performance in relation to the action context. To assess each player’s relative participation, we also introduced relative contextual coefficients. We analyzed 20 games played by the world’s top eight teams during the 2019 FIVB Women’s Club World Championship, using Data Volley software and Python programming. We evaluated inter- and intra-observer reliability and used binomial logistic regression models to estimate each variable’s probability of having contributed to the team’s set win. We calculated estimated confidence intervals, standard errors, and Wald values; and we employed Akaike’s and Bayesian criteria to evaluate the model’s goodness of fit. We identified optimal cut-off points using receiver operating characteristic curves, and we found that the proposed contextual evaluation coefficients prevented overestimation of a player’s technical performance in uneven situations. We addressed the issue in which the winning team may be the one that scored the fewest points, and we were able to predict a team’s victory with confidence. The proposed coefficients made multiple technical and contextual aspects of the game easily accessible and comprehensible, offering significant beneficial implications for coaches and players.
Analysis of the characteristics of valveless piezoelectric pump with crescent dune bluff body
Authors: Xie Changxiong , Zhou Shuaishuai , Zhang Yong , Wang Jianchen , Deng Xiaolei , Yang Jun
Published: November 2023

To improve the output flow characteristics of the piezoelectric pump in one direction, a new valveless piezoelectric pump with a crescent dune bluff body has been proposed. The pump can achieve low damage to the active substance on the premise that the active cell can guarantee the transport volume. By comparing with the hemispherically deficient and imitated meniscus resistance fluid, the barchan dune resistance fluid which can effectively improve the unidirectional output of the piezoelectric pump is obtained. Combined with the pump theoretical flow calculation formula, these influencing parameters, the degree of inclination, the sand ridge radius and the order of the crescent dune were analyzed. Finally, an experimental prototype of a valveless piezoelectric pump has been fabricated by 3D printing technology, and the pump flow test is being conducted. The relationship between frequency, voltage and output flow has been obtained. The test results show that with a dune inclination of 37.5, a sand ridge radius of 6.75 mm and a dune order of 4, the flow rate of the piezoelectric pump is best at 194.7 mL/min. The experimental results agree with the simulation results, showing the effectiveness of the valveless piezoelectric pump structure.
Fatigue analysis and optimization design of key components of synthesizing equipment for artificial diamond based on a method of information exchange system
Authors: Jia Jiguang , Sun Xuan , Chen Zhihui , Shang Jin , Liu Ting
Published: November 2023

In this article, a method of information exchange system (MIES) has been proposed to optimize the structure of the hinge sleeve of cubic (HSC), a key component of synthetic diamond. The MIES method integrates static analysis, topology optimization, and fatigue failure analysis. By using this method, the lightweight design of the structure was ensured while meeting the fatigue life requirements. The weight of the optimized model was reduced from 5729.9 kg to 4593.4 kg, and the fatigue life was 1.127E+05, which meets the serviceability requirements. The steps of the method are as follows: First, the model of HSC was established. According to the loading conditions, the basic material data and boundary conditions were set, and the stresses and strains of the HSC were calculated. The optimized region was obtained by topological analysis of the HSC structure using the variable density method. The fatigue life of the model was then calculated by combining the stress life method and the average stress correction method. Simulations were performed using the above method to obtain the six nodes of maximum stress in the HSC. These nodes were used as control points for the structural optimization design. The HSC model was optimized by optimizing the structure in the region of the control variable points. Computational analysis of the optimized HSC model was carried out using the information exchange system. After repeated optimization of the structure of the HSC model, a model with a lightweight design was obtained. The ANSYS simulation results showed that the final mass of the HSC model was reduced by 19.83%. Stress and life were within the design requirements. The information exchange system has better computational performance, feasibility, and reliability compared to traditional theoretical methods.
Effective Union Leadership: Evidence from the Harvard Trade Union Program
Authors: Kaminski Michelle
Published: November 2023

This study draws on three well-established streams of leadership research: transformational leadership, servant leadership, and five-factor personality theory and applies them to the labor union context. The study tested the relationship between these theories and both leader and union effectiveness. The sample consisted of 240 respondents who rated the leadership of 60 participants in the 2018 and 2019 Harvard Trade Union Program. Results indicated that the best predictors of both leader effectiveness and union effectiveness were the transformational and servant leadership styles. In contrast with other research, the five-factor personality variables (extraversion, conscientiousness, emotional stability, openness, and agreeableness) had no significant relationship with leadership effectiveness after controlling for the leadership style models. Only two of the five personality variables, extraversion and emotional stability, were related to union effectiveness after controlling for the effects of transformational and servant leadership. Discussion includes implication for labor educators.
“Stick to Sports” and Critical Sports Media Industry Studies
Authors: Burroughs Benjamin , Nettingham Shi-Quan , Nourse Dave
Published: November 2023

This research aims at unpacking the discourse of “stick to sports,” which audiences and industry wield to police social and cultural boundaries involving corporate control, race, gender, and politics. The “stick to sports” discourse is increasingly prevalent in sports discourse, but also national political discourse, and is used to dictate who can and cannot speak and what kinds of discussions are appropriate concerning sports and politics. In this article, the sports media franchise ESPN and their “No-Politics” policy, media personality Clay Travis’ PragerU polemic, Dan Le Batard, and Jemele Hill are analyzed as sites for understanding how corporations leverage this discourse to claim neutrality or unity while disciplining employees for veering too far politically. This paper analyzes “stick to sports” through industry practices and textual extensions of the discourse, calling for sports media and communication as a discipline to incorporate a critical sports media industry studies (CSMIS) approach.
Book review: Swati Ganguly, Tagore’s University: A History of Visva-Bharati, 1921–1961
Authors: Sarkar Abhishek
Published: November 2023

Swati Ganguly, Tagore’s University: A History of Visva-Bharati, 1921–1961 (Ranikhet: Permanent Black, 2022), xx + 488 pp.
Thinglhang Lou: Linkages Between Swidden, Culture, and Ecology in Manipur, Northeast India
Authors: Haokip Thanglienmang , Aiyadurai Ambika
Published: November 2023

Emerging human ecological discussions bring forth literature and studies from marginalised groups and indigenous communities whose knowledge about nature and subsistence livelihood practices have long been seen as ‘non-scientific’ and, therefore, unworthy of serious research. As a result, perceptions of swidden cultivation as ‘destructive’ to ecosystems are changing, and studies now focus on the interlinkages of swidden farmers with land, animals, identity, and livelihoods. In this paper, we argue that swidden should be considered as a farming practice that goes beyond subsistence and overlaps with people's belief systems and social and eco-cultural lifeways. Using the notion of thinglhang lou, the swidden practice of Manipur's Kuki, we show the interlinkages between land, humans, and spirits and the important role they play in their socio-cultural worlds. Through ethnographic exploration involving participant observation, interviews, and focus group discussions among the Kuki, this study shows how and in what ways swidden farming helps in understanding cultural linkages with ecological sustainability. With modern developments radically altering the habitat and eroding cultural heritage, we argue that Kuki's notion of thinglhang lou can be a powerful contribution to our understanding of the environment and knowledge systems.
Sectarianism as racism: the collective punishment of Alevi communities in Turkey
Authors: Yonucu Deniz
Published: November 2023

Drawing on the case of state-sanctioned violence and discrimination against Alevis, a historically stigmatised and persecuted ethnosectarian community in Turkey, this article shows that sectarian identities can also be raced. The case of Alevis in Turkey not only indicates how sectarianism can function as a form of racism but also offers an example of the connection between the production of race and the politics of death. Approaching racism as a punitive mechanism and form of collective punishment that punishes racialised communities at different levels and that constantly reminds them of the possibility of what Gilmore terms ‘premature death’, the article offers a new and nuanced understanding of the multiple modalities of racism in Turkey. Rather than viewing racism in Turkey as merely an imitative form of European racism, this article shows that racism in Turkey is also informed by the country’s own imperial past. Turkey provides fertile ground for examining both western and non-western forms of racism and the intersections between the two.
COVID-19 and SLE: Infection and autoimmunity at its best
Authors: Mahroum Naim , Elsalti Abdulrahman , Ozkan Mehmet Fatih , Shoenfeld Yehuda
Published: November 2023

If one had any doubts before the pandemic regarding the correlation between infections and autoimmunity, COVID-19 left us fascinated on the strong bond between the two entities. The immune and autoimmune reactions seen in patients infected with SARS-CoV-2 have served as a base for this assumption. Later on, the use of immunosuppressants such as systemic glucocorticoids, among other biological agents, turned this assumption to a fact. This was no different when it comes to the vaccines against COVID-19. Through several postulated mechanisms these vaccines, although generally considered safe, are thought to have the potential to result in autoimmune reactions making them not more innocent than the infection itself. When systemic lupus erythematous (SLE) is viewed as a classical autoimmune multisystemic disorder, the connection with SARS-CoV-2 infection and COVID-19 vaccination is of extreme importance. This is because early reports during the pandemic have shown increased rates of SARS-CoV-2 infection among patients known previously to have SLE and much more interestingly, cases of new-onset SLE after COVID-19 have been documented in the literature. Subsequently vaccines against COVID-19, those mRNA-based and adenovirus-vector based, were reported to induce new SLE cases, trigger immune thrombocytopenia or lupus nephritis, two common presentations of SLE, or exacerbate flares. In our paper, we concluded various aspects of available and recent data regarding SLE and COVID-19 as both an infection and vaccination.
Apna Store and E-commerce: Meeting Consumer Needs During COVID-19
Authors: Kapoor Sheetal , Sivadas Eugene
Published: November 2023

Apna Store, a family-owned ‘kirana’ neighbourhood grocery store in suburban New Delhi, India, offers a diverse selection of 15,000 products. This case revolves around its owner, Mr Jagmohan Trehan, who faces a pivotal decision due to the ongoing COVID-19 pandemic: whether to revamp the store’s product range and venture into e-commerce.

The pandemic has dramatically altered consumer behaviour, with a surge in online grocery shopping. E-commerce vendors’ enticing promotions and the entry of Reliance Jio with a unique business model have presented opportunities and challenges to Mr Trehan and the kirana store industry, the backbone of India’s retail sector. In March 2020, the pandemic prompted panic buying and shifts in consumer preferences, compelling Apna Store to adapt during the lockdown. As online grocery shopping gained traction, the idea of entering e-commerce emerged, but with reservations. In April 2021, as India faced another pandemic wave, consumers became more comfortable with online grocery shopping, and e-commerce operators improved supply chains and delivery. This case centres on whether Apna Store should embrace e-commerce and the associated costs and benefits.