bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of metformin treatment on cobalamin status in persons with type 2 diabetes
Authors: Fituri Sundus , Akbar Zoha , Ganji Vijay
Published: May 2023

Over the last decades, low vitamin B12 status has been reported in individuals with type 2 diabetes mellitus (T2DM). Metformin, the first-line therapy for lowering blood glucose, is the main driving factor behind this association. Although the relationship between vitamin B12 deficiency and metformin is well established, results of studies on the exact effect of the dose and duration of the therapy remain inconsistent. Additionally, a lack of consensus on the definition of vitamin B12 deficiency adds to the conflicting literature. The objectives of this review were to analyze and synthesize the findings on the effects of metformin dose and duration on vitamin B12 status in patients with T2DM and to outline the potential mechanisms underlying metformin’s effect on vitamin B12. Metformin therapy has adversely affected serum vitamin B12 concentrations, a marker of vitamin B12 status. The metformin usage index (a composite score of metformin dose and duration) might serve as a potential risk assessment tool for vitamin B12 screening in patients with T2DM. Considering the health implications of suboptimal vitamin B12 status, vitamin B12 concentrations should be monitored periodically in high-risk patients, such as vegans who are receiving metformin therapy for T2DM. Additionally, it is prudent to implement lifestyle strategies concurrent with metformin therapy in individuals with T2DM, promoting an overall synergistic effect on their glycemic control.
Blueberry, cranberry, raspberry, and strawberry as modulators of the gut microbiota: target for treatment of gut dysbiosis in chronic kidney disease? From current evidence to future possibilities
Authors: Coutinho-Wolino Karen S , Melo Manuela F S , Mota Jessica C , Mafra Denise , Guimarães Jonas T , Stockler-Pinto Milena B
Published: May 2023

Gut dysbiosis is common in patients with chronic kidney disease (CKD) and is associated with uremic toxin production, inflammation, oxidative stress, and cardiovascular disease development. Therefore, healthy dietary patterns are essential modulators of gut microbiota. In this context, studies suggest that consuming berry fruits, rich in polyphenols and nutrients, may positively affect the gut microbiota, promoting the selective growth of beneficial bacteria and improving clinical status. However, studies on the effects of berry fruits on gut microbiota in CKD are scarce, and a better understanding of the possible mechanisms of action of berry fruits on gut microbiota is needed to guide future clinical studies and clinical practice in CKD. The objective was to discuss how berry fruits (blueberry, cranberry, raspberry, and strawberry) could be a therapeutic strategy to modulate the gut microbiota and possibly reverse the dysbiosis in CKD. Overall, available evidence shows that berry fruits can promote an increase in diversity by affecting the abundance of mucus-producing bacteria and short-chain fatty acids. Moreover, these fruits can increase the expression of mRNA involved in tight junctions in the gut such as occludin, tight junction protein 1 (TJP1), and mucin. Studies on the exact amount of berries leading to these effects show heterogeneous findings. However, it is known that, with 5 mg/day, it is already possible to observe some effects in animal models. Wild berries could possibly improve the uremic condition by reducing the levels of uremic toxins via modulation of the gut microbiota. In the long term, this could be an excellent strategy for patients with CKD. Therefore, clinical studies are encouraged to evaluate better these effects on CKD as well as the safe amount of these fruits in order to promote a better quality of life or even the survival of these patients.
Clindamycin plus Vancomycin versus Linezolid for Treatment of Necrotizing Soft Tissue Infection
Authors: Dorazio Joshua , Chiappelli Abby L , Shields Ryan K , Tsai Y Vivian , Skinker Peyton , Nabozny Michael J , Bauza Graciela , Forsythe Raquel , Rosengart Matthew R , Gunn Scott R , Marini Rachel , Clarke Lloyd , Falcione Bonnie , Ludwig Justin , McCreary Erin K
Published: May 2023

Background

Necrotizing soft tissue infections (NSTIs) are life-threatening infections. The aim of this study is to evaluate the safety of clindamycin plus vancomycin versus linezolid as empiric treatment of NSTI.

Methods

Retrospective, single-center, quasi-experimental study of patients admitted from June 1, 2018 to June 30, 2019 (pre-intervention) and May 1, 2020 to October 15, 2021 (post-intervention). Patients who received surgical management within 24 hours of NSTI diagnosis and at least one dose of linezolid or clindamycin were included. The primary endpoint was death at 30 days. The secondary outcomes included rates of acute kidney injury (AKI) and Clostridioides difficile infection (CDI).

Results

274 patients were identified by admission diagnosis code for NSTI or Fournier’s Gangrene; 164 patients met the inclusion criteria. Sixty-two matched pairs were evaluated. There was no difference in rates of 30-day mortality (8.06% vs. 6.45%, HR 1.67 95%CI (0.32, 10.73), p = 0.65). There was no difference in CDI (6.45% vs. 1.61%, HR Inf 95%CI (0.66, Inf), p = 0.07) but more AKI in the pre-intervention group (9.68% vs. 1.61%, HR 6 95% CI (0.73, 276), p = 0.05).

Conclusions

In this small, retrospective, single-center, quasi-experimental study, there was no difference in 30-day mortality in patients receiving treatment with clindamycin plus vancomycin versus linezolid in combination with standard gram-negative and anaerobic therapy and surgical debridement for the treatment of NSTI. A composite outcome of death, AKI, or CDI within 30 days was more common in the clindamycin plus vancomycin group.
Relugolix in Clinical Practice: The Best Route for All?
Authors: Cordes Lisa M , Karzai Fatima , Figg William D , Madan Ravi A
Published: May 2023

Androgen deprivation therapy (ADT) has been a mainstay of prostate cancer treatment for decades. Relugolix was FDA-approved in 2020 and is currently the only ADT option via an oral route. While the opportunity to use an oral medication for this indication has some advantages, a balanced discussion is required to understand in what clinical settings this agent truly has benefit over long-acting injectable formulations of ADT. Furthermore, patient preference, compliance, financial toxicity, and perhaps most importantly, pharmacologic characteristics must be considered.
First gene-edited calf with reduced susceptibility to a major viral pathogen
Authors: Workman Aspen M , Heaton Michael P , Vander Ley Brian L , Webster Dennis A , Sherry Luke , Bostrom Jonathan R , Larson Sabreena , Kalbfleisch Theodore S , Harhay Gregory P , Jobman Erin E , Carlson Daniel F , Sonstegard Tad S
Published: May 2023

Bovine viral diarrhea virus (BVDV) is one of the most important viruses affecting the health and well-being of bovine species throughout the world. Here, we used CRISPR-mediated homology-directed repair and somatic cell nuclear transfer to produce a live calf with a six amino acid substitution in the BVDV binding domain of bovine CD46. The result was a gene-edited calf with dramatically reduced susceptibility to infection as measured by reduced clinical signs and the lack of viral infection in white blood cells. The edited calf has no off-target edits and appears normal and healthy at 20 months of age without obvious adverse effects from the on-target edit. This precision bred, proof-of-concept animal provides the first evidence that intentional genome alterations in the CD46 gene may reduce the burden of BVDV-associated diseases in cattle and is consistent with our stepwise, in vitro and ex vivo experiments with cell lines and matched fetal clones.
Systematic review of determinants and interventions of areca nut cessation: curbing a public health menace
Authors: Muralidhar Kiranmayee , Madhivanan Purnima
Published: May 2023

This letter presents a critical appraisal of a recent systematic review article published in Journal of Public Health. Systematic reviews are particularly important research articles that can meaningfully influence policy and research in the field due to their scientific value. We aimed to bring attention to certain methodological issues in this review that affect the validity of the findings on the very important topic of areca nut use and cessation.
Ultra-small superparamagnetic iron oxide nanoparticles for intra-articular targeting of cartilage in early osteoarthritis
Authors: Wu Jun , Wu Changqiang , Cai Zhongyuan , Gu Haojie , Liu Li , Xia Chunchao , Lui Su , Gong Qiyong , Song Bin , Ai Hua
Published: May 2023

Early diagnosis of osteoarthritis (OA) is critical for effective cartilage repair. However, lack of blood vessels in articular cartilage poses a barrier to contrast agent delivery and subsequent diagnostic imaging. To address this challenge, we proposed to develop ultra-small superparamagnetic iron oxide nanoparticles (SPIONs, 4 nm) that can penetrate into the matrix of articular cartilage, and further modified with the peptide ligand WYRGRL (particle size, 5.9 nm), which allows SPIONs to bind to type II collagen in the cartilage matrix and increase the retention of probes. Type II collagen in the cartilage matrix is gradually lost with the progression of OA, consequently, the binding of peptide-modified ultra-small SPIONs to type II collagen in the OA cartilage matrix is less, thus presenting different magnetic resonance (MR) signals in OA group from the normal ones. By introducing the AND logical operation, damaged cartilage can be differentiated from the surrounding normal tissue on T1 and T2 AND logical map of MR images, and this was also verified in histology studies. Overall, this work provides an effective strategy for delivering nanosized imaging agents to articular cartilage, which could potentially be used to diagnosis joint-related diseases such as osteoarthritis.
Translatio Materiae: Spenser’s Poetics of Matter
Authors: Pipas Victoria Florio
Published: May 2023

This article argues that sixteenth-century humanist depictions of Rome’s decay, together with paradigms of translatio imperii et studii, shape Edmund Spenser’s poetics of matter. The article identifies a new translatio in Spenser’s corpus, translatio materiae—matter’s movement or change—born from Spenser’s contact with and Complaints (1591) translation of Joachim du Bellay’s sonnet sequence, Les Antiquitez de Rome (1553). Where earlier humanists represent the recovery and reincorporation of Rome’s material remains as a metaphor for carrying forward antique power and artistry, Spenser transforms this image of material translatio into a law governing depicted matter’s movement and change in his Faerie Queene (1590/96). Translatio materiae runs through Spenser’s corpus as represented matter’s resurrection from states of decay into material afterlives as narrative object or poetic device. I examine this phenomenon in key heroic episodes of Faerie Queene Book One, episodes which I treat as exemplary of matter’s preservation, proliferation, and translatio as compositional strategies in the poem’s narrative and structure. Translatio materiae’s use in the poem thus points to a Spenserian theory of imitation that resists the teleology of prior translatio paradigms and instead understands Renaissance imitation to exhibit all the waywardness of matter.
Otters and Others: Ted Hughes to John Kinsella
Authors: Kerrigan John
Published: May 2023

Attitudes to animals and their relationship with the human have undergone significant changes over the last six decades, from the rise of the environmental movement to debates about genetic modification. Poetry has responded to these developments but also contributed to argument and activism. This essay aims to make sense of this history and its literary consequences by investigating the representation of otters in the work of a series of poets from Ted Hughes to John Kinsella. Shape-shifting, elusive, never entirely other, otters allow writers to negotiate the fluid boundary between animal and human and the value of what is wild. They enable explorations of sexuality, the attraction of animals as re-makers of human geography, and the risk to all life forms posed by pollution and nuclear contamination. By analysing a range of work from Britain and Ireland, with some attention to American and Australian contexts and the international rise of Bio Art, the discussion aims to clarify both how views of the natural have been reconfigured and how these shifts animate very different kinds of verse, from the formality of Seamus Heaney and Alice Oswald to the late modernism of Colin Simms and Maggie O’Sullivan.
Optimal Long-Term Health Insurance Contracts: Characterization, Computation, and Welfare Effects
Authors: Ghili Soheil , Handel Ben , Hendel Igal , Whinston Michael D
Published: May 2023

Reclassification risk is a major concern in health insurance where contracts are typically 1 year in length but health shocks often persist for much longer. While most health systems with private insurers pair short-run contracts with substantial pricing regulations to reduce reclassification risk, long-term contracts with one-sided insurer commitment have significant potential to reduce reclassification risk without the negative side effects of price regulation, such as adverse selection. We theoretically characterize optimal long-term insurance contracts with one-sided commitment, extending the literature in directions necessary for studying health insurance markets. We leverage this characterization to provide a simple algorithm for computing optimal contracts from primitives. We estimate key market fundamentals using data on all under-65 privately insured consumers in Utah. We find that dynamic contracts are very effective at reducing reclassification risk for consumers who arrive at the market in good health, but they are ineffective for consumers who come to the market in bad health, demonstrating that there is a role for the government insurance of pre-market health risks. Individuals with steeply rising income profiles find front-loading costly, and thus relatively prefer ACA-type exchanges. Switching costs enhance, while myopia moderately compromises, the performance of dynamic contracts.
Treatment with mycophenolate mofetil is associated with improved nailfold vasculature in systemic sclerosis
Authors: Wildt Marie , Andréasson Kristofer , Hamberg Viggo , Hesselstrand Roger , Wuttge Dirk M
Published: May 2023

Objective

To investigate the evolution of nailfold capillary density in patients with SSc in relation to immunosuppressive treatment and autoantibodies.

Methods

This was a prospective study cohort. Consecutive newly diagnosed SSc patients were included into this study who, in a retrospective review, had at least two nailfold capillary microscopy measurements performed during the first 48 months of follow-up. Capillary density per 3 mm was measured with widefield nailfold capillary microscopy. Improvement of capillary density per finger and mean capillary density were analysed. Longitudinal measurements of mean capillary density were analysed by generalized estimating equation.

Results

Eighty patients (68 women, 12 men) met the inclusion criteria. The median follow-up time was 27 months. Twenty-eight patients had an improved capillary density in per-finger analysis. MMF was associated with fewer numbers of fingers that had worsened in capillary density. Anti-topoisomerase antibodies were associated with low mean capillary density. Anti-RNA polymerase III antibodies were associated with improvement and anti-centromere antibodies with worsening of capillary density in per-finger analysis. MMF treatment was associated with less steep capillary density decline in a moderated generalized estimating equation model including presence of anti-topoisomerase antibodies and the interaction of MMF with follow-up time.

Conclusion

Nailfold capillary density improved over time in a substantial proportion of SSc patients. MMF treatment had a positive impact on the evolution of capillary density in these patients. SSc autoantibody phenotype may affect the capillary density development. The data support previous hypotheses that early immunosuppression may favourably affect vascular regeneration in SSc.
Religion and Subjective Social Class in the United States
Authors: Schwadel Philip
Published: May 2023

Subjective social class identities—lower, working, middle, and upper—are conditioned by culture and social interactions. I argue that conservative Christianity influences subjective class identification because conservative Christian social networks are highly insular, and its culture prioritizes lower- and working-class ideologies. Using nationally representative data, I find that conservative Christians—operationalized with views of the Bible and religious tradition—are relatively likely to identify as lower and working class, and unlikely to identify as middle and upper class; that these associations are partially but not wholly mediated by higher education and family income; and that there are robust associations between religion and subjective class among those with a bachelor’s degree and above-average family incomes, but not among less-educated and lower-income Americans. These results indicate that conservative Christianity promotes a specific class culture, and that this class culture more closely aligns with biblical literalism than with affiliation with evangelical Protestant churches.
Cyprus international trusts as a legal arrangement that is immune to forced heirship claims
Authors: Kammitsi Stella
Published: May 2023

The portions of a deceased’s estate that can effectively be passed to surviving family members depend largely on the laws and regulations of each jurisdiction coupled with applicable EU Regulations and international conventions. Succession laws, wills and trusts, may face the challenges of forced heirship provisions that one may attempt to bypass by creating an inter vivos or testamentary trust, but which carry the risk of being disputed. Cyprus trust law does not recognise forced heirship claims against trust assets. The law relating to inheritance or succession in Cyprus or in any other country does not in any way affect any transfer or disposition of assets to a Cyprus International Trust or the validity of the trust.
Adjudication by an arbitration court of legal disputes arising from trust relationships
Authors: Kun Péter , Sándor István , Spiriev Olivér
Published: May 2023

The Hungarian act on arbitration has recently undergone two significant amendments. After 1 January 2018, the legislator prohibited the arbitrability of contracts concluded with consumers, and from 1 January 2021, it became possible to settle disputes arising in connection with trust (fiduciary asset management) relationships before an arbitration court. The study analyses the connections between the two amendments, presenting the advantages of arbitration in respect of legal disputes arising out of trust relationships, and the issues of legal interpretation that may arise in the current Hungarian legal environment based on foreign examples. In the present article, we wished to address the issue of the arguments and counter-arguments that made it necessary to amend the Hungarian act on arbitration (“Arbitration Act”1) in order to allow for the arbitration of disputes arising from trust (or what Hungarian law terms “fiduciary asset management”) relationships.
Ketorolac as a Local Analgesic in Orthopaedic Conditions: A Systematic Review of Safety and Efficacy
Authors: Eskew Joshua , Kelly Tyler , Ode Gabriella
Published: May 2023

Effective pain management is essential in the treatment of musculoskeletal pathology. Corticosteroid injections have long been used both locally and systemically for their analgesic and anti-inflammatory properties in orthopedic conditions. Opioids have long been used in the perioperative setting to optimize pain control, however both corticosteroids and opioids are not without harm. Ketorolac, a nonsteroidal anti-inflammatory (NSAID) has shown to be effective as an anti-inflammatory and analgesic agent in and outside the perioperative setting with less risk of local and systemic side effects. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant publications were identified searching the PubMed database and EMBASE. The initial search totaled 3,978 articles. After thorough review, 21 full text manuscripts were included (Fig. 1 – PRISMA Chart). 21 full text manuscripts were reviewed assessing over 3,100 who received a local injection of Toradol. Overall, the studies reviewed universally demonstrated an excellent safety profile for ketorolac both systemically and locally. Clinical studies have shown that local application of ketorolac demonstrated decreased postoperative pain, decreased lengths of hospital stays, and decrease postoperative opioid use. This is the first ever study to assess the efficacy, safety profile, and postoperative outcomes with local use of ketorolac injections in musculoskeletal pathology. The local use of ketorolac in the intra-articular and peri-articular setting provides a safe and effective adjunct or alternative treatment in patients with musculoskeletal ailments.
A Randomized, Multicenter, Evaluator-blind Study to Evaluate the Safety and Effectiveness of VYC-12L Treatment for Skin Quality Improvements
Authors: Alexiades Macrene , Palm Melanie D. , Kaufman-Janette Joely , Papel Ira , Cross Sarah J. , Abrams Steve , Chawla Smita
Published: May 2023

BACKGROUND

Skin quality may be assessed by degrees of skin smoothness, fine lines, and hydration. VYC-12L is a recently developed hyaluronic acid filler to improve skin quality.

OBJECTIVE

This was a randomized, evaluator-blind study assessing safety and effectiveness of intradermal VYC-12L treatment for improving cheek skin smoothness, fine lines, and hydration.

METHODS

Participants (≥22 years) with moderate-to-severe investigator-assessed Allergan Cheek Smoothness Scale (ACSS) scores were randomized in 2:1 ratio to receive VYC-12L or control (no treatment with optional treatment). Effectiveness was assessed 1 month after last injection (initial or touch-up) by a responder rate (≥1-grade improvement from baseline on both cheeks) using investigator-rated ACSS and Allergan Fine Lines Scale (AFLS), and tissue dielectric constant probe-measured skin hydration. Safety was evaluated throughout.

RESULTS

Participants (VYC-12L, n = 131; control, n = 71) were 86.1% female with a median age of 58.0 years. At month 1, ACSS and AFLS responder rates were statistically significantly higher in the VYC-12L group (57.9%, 58.3%, respectively) than in the untreated controls (4.5%, 5.4%, respectively; p < .001). VYC-12L ACSS and AFLS responder rates remained consistent throughout the 6-month follow-up. Six participants reported treatment-related adverse events; none led to study discontinuation.

CONCLUSION

VYC-12L is an effective, well-tolerated treatment for lasting improvement of cheek skin smoothness, fine lines, and hydration.
Risk factors for intrauterine device embedment in postmenopausal women: an analysis of 731 participants undergoing hysteroscopy
Authors: Jiang Jilan , Bian Shoufang , Li Sen , Wang Shuying
Published: May 2023

Objective

This study aimed to explore the risk factors for intrauterine device (IUD) embedment in postmenopausal women.

Methods

A total of 731 women who underwent hysteroscopy for IUD removal from January 2019 to December 2021 were included in the trial, of whom 301 were diagnosed with IUD embedment (embedded group) and 430 had a normal IUD location (control group). The following data were collected from electronic medical records: demographic traits, ultrasound findings, IUD shapes, uterine features, and hysteroscopy findings. Bivariate contingency analysis and multiple logistic regression were performed to identify the significant independent variables that affect IUD embedment.

Results

Prior IUD removal failure (14.3% vs 5.1%; adjusted odds ratio [aOR], 3.29; 95% CI, 1.90-5.71) and V-shaped IUD (18.9% vs 10.7%; aOR, 2.05; 95% CI, 1.33-3.16) were risk factors that were independently linked with IUD embedment. Uterine volume (22.7 [20.9-24.5] cm3 vs 27.9 [24.8-30.9] cm3; aOR, 0.99; 95% CI, 0.982-0.999) was negatively linked with IUD embedment. There were no differences in age, parity, menopause length, years with an IUD in situ, uterine position, or abortion times between the two groups. There were no differences in existing leiomyoma, prior cervical LEEP (loop electrosurgical excision procedure), or myomectomy between the two groups.

Conclusions

Prior IUD removal failure, V-shaped IUD, and a smaller uterine volume were risk factors for IUD embedment in menopausal women.
Trajectories of depressive symptoms over 20 years and subsequent lower urinary tract symptoms and impact among women
Authors: Brady Sonya S. , Shan Liang , Markland Alayne D. , Huling Jared D. , Arguedas Andrés , Fok Cynthia S. , Van Den Eeden Stephen K. , Lewis Cora E.
Published: May 2023

Objective

The aim of the study is to examine the association between depressive symptoms and subsequent lower urinary tract symptoms (LUTS) and impact (a composite outcome) among women (N = 1,119) from the Coronary Artery Risk Development in Young Adults study.

Methods

The Center for Epidemiologic Studies-Depression Scale (CES-D) was administered in 1990–1991 and every 5 years through 2010–2011. In 2012–2013, LUTS and impact data were collected for the first time. Accumulation of risk was examined in the following three ways: (1) mean CES-D score across 20 years (5 observations); (2) depressive symptom trajectory group, determined by group-based trajectory modeling; and (3) intercepts and slopes obtained from women's individual CES-D score trajectories through two-stage mixed effects modeling. For each approach, ordinal logistic regression analyses examined odds of having “greater LUTS/impact” for each unit change in a depressive symptom variable.

Results

(1) With each one-unit increase in mean CES-D score over the 20-year period, women were 9% more likely to report greater LUTS/impact (odds ratio [OR] = 1.09, 95% CI = 1.07-1.11). (2) In comparison with women with consistently low depressive symptoms, women with consistently threshold depression or consistently high depressive symptoms were twice (OR = 2.07, 95% CI = 1.59-2.69) and over five times (OR = 5.55, 95% CI = 3.07-10.06) as likely, respectively, to report greater LUTS/impact. (3) Women's individual symptom intercept and slope interacted. Increases in depressive symptoms across 20 years (greater slopes) were associated with greater LUTS/impact when women's initial CES-D score (intercept) was in the moderate-to-high range relative to the sample.

Conclusions

Depressive symptoms over 20 years, examined with different degrees of nuance, were consistently associated with subsequently measured LUTS and impact.
Association of parity with body mass index and cardiometabolic risk in high-parous women
Authors: He Shisi , McArdle Patrick F. , Ryan Kathleen A. , Daue Melanie , Xu Huichun , Barry Kathryn Hughes , Magder Laurence S. , Shuldiner Alan R. , Pollin Toni I. , Mitchell Braxton D.
Published: May 2023

Objective

Postpregnancy weight retention contributes to obesity, but the long-term effect of parity on body mass index (BMI) and other cardiometabolic risk factors is unclear. We aimed to evaluate the relationship between parity and BMI among highly parous Amish women, both before and after menopause, and to evaluate the associations of parity with glucose, blood pressure, and lipids.

Methods

We conducted a cross-sectional study among 3,141 Amish women 18 years or older from Lancaster County, PA, who participated in our community-based Amish Research Program between 2003 and 2020. We evaluated the association between parity and BMI across different age groups, both before and after the menopausal transition. We further assessed associations between parity and cardiometabolic risk factors among the 1,128 postmenopausal women. Finally, we evaluated the association of change in parity with change in BMI in 561 women followed longitudinally.

Results

Approximately 62% of women in this sample (mean age, 45.2 y) reported having four or more children, and 36% reported having seven or more. A one-child increase in parity was associated with increased BMI in both premenopausal women (estimate [95% confidence interval], 0.4 kg/m2 [0.2–0.5]) and to a lesser degree in postmenopausal women (0.2 kg/m2 [0.02–0.3], P
int = 0.02), suggesting that the impact of parity on BMI decreases over time. Parity was not associated with glucose, blood pressure, total cholesterol, low-density lipoprotein, or triglycerides (P
adj > 0.05).

Conclusions

Higher parity was associated with increased BMI in both premenopausal and postmenopausal women, but more so in younger/premenopausal women. Parity was not associated with other indices of cardiometabolic risk.
Time to Radiation after Oncoplastic Reduction versus After Lumpectomy
Authors: Marxen Troy , Chan Patricia , Baker Nusaiba , Godette Karen D. , Styblo Toncred M. , Carlson Grant W. , Losken Albert
Published: May 2023

Background:

Prior studies contrasting oncoplastic reduction (OCR) to traditional lumpectomy have validated oncoplastic reduction surgery with similar survival and oncological outcomes. The purpose of this study was to evaluate if there was a significant difference in the time to initiation of radiation therapy after OCR in comparison with the standard breast-conserving therapy (lumpectomy).

Methods:

The patients included were from a database of breast cancer patients who all underwent postoperative adjuvant radiation after either OCR or lumpectomy at a single institution between 2003 and 2020. Patients who experienced delays in radiation for nonsurgical reasons were excluded. Comparisons were made between the groups in the time to radiation and complication rates.

Results:

A total of 487 patients underwent breast-conserving therapy, with 220 having undergone OCR and 267 lumpectomy patients. There was no significant difference in days to radiation between patient cohorts (60.5 OCR, 56.2 lumpectomy, P = 0.059). There was a significant difference in the number of complications between OCR and lumpectomy patients (20.4% OCR, 2.2% lumpectomy, P < 0.001). However, of patients who had complications, there was no significant difference in the number of days to radiation (74.3 OCR, 69.3 lumpectomy, P = 0.732).

Conclusions:

Compared with lumpectomy, OCR was not associated with an increased time to radiation but was associated with higher complications. Statistical analysis did not reveal surgical technique or complications to be independent, significant predictors of increased time to radiation. Surgeons should be aware that although complications may remain higher in OCR, this does not necessarily translate to delays in radiation.
Overcoming Pandemic-Related Challenges in Recruitment and Screening
Authors: Halloway Shannon , Volgman Annabelle Santos , Schoeny Michael E. , Arvanitakis Zoe , Barnes Lisa L. , Pressler Susan J. , Vispute Sachin , Braun Lynne T. , Tafini Susan , Williams Martina , Wilbur JoEllen
Published: May 2023

Background

Recruiting participants with cardiovascular disease into research during the COVID-19 pandemic was challenging, particularly those at risk of health disparities.

Objective

During the pandemic, 12 cohorts of older women with cardiovascular disease were recruited from cardiology clinics into a lifestyle intervention trial to prevent cognitive decline. Objectives were to (a) describe the results of modified recruitment/screening strategies to overcome pandemic-related challenges and (b) evaluate differences in age, race, and ethnicity between patients recruited/randomized, recruited/not randomized (entered recruitment but not randomized because of being ineligible or not interested), and not recruited (clinic patients who met preliminary criteria but did not enter recruitment).

Methods

This was a cross-sectional descriptive analysis. In-person study strategies proposed before the COVID-19 pandemic were modified before study onset (September 2020). Women 65 years or older with cardiovascular disease were recruited from cardiology clinics by clinicians, posted flyers, and letters mailed to patients randomly selected from electronic health record data extractions. Patients were classified as recruited/randomized, recruited/not randomized, and not recruited.

Results

Of 5719 patients potentially eligible, 1689 patients entered recruitment via referral (49.1%), posted flyers (0.5%), or mailed letters (50.3%), and 253 patients were successfully recruited/randomized. Recruited/randomized participants were, on average, 72.4 years old (range, 65–90 years old), non-Hispanic White (54.2%), non-Hispanic Black (38.3%), Hispanic/Latinx (1.6%), and other/not reported (5.1%). The recruited/randomized group was significantly younger with fewer patients of Hispanic/Latinx ethnicity compared with those not recruited.

Conclusions

During the pandemic, all recruitment/screening goals were met using modified strategies. Differences in sociodemographic representation indicate a need for tailored strategies.
Associations of Prenatal Agricultural Farm Work with Fetal Overgrowth and Pregnancy Complications in State of Arizona Birth Records
Authors: Parra Kimberly L. , Harris Robin B. , Farland Leslie V. , Beamer Paloma , Furlong Melissa
Published: May 2023

Objective

The purpose of this study is to examine fetal growth outcomes from agricultural worker households.

Methods

Using Arizona 2006 to 2013 birth certificates with parental occupation, we identified N = 623,185 live births by agricultural household status. Logistic regression models estimated adjusted odds ratios (aORs) for macrosomia (>4000 g), postterm birth (>41 weeks), low birth weight (<2500 g), preterm birth (<37 weeks), large for GA, small for GA, and 5-minute APGAR (<7).

Results

Newborns of agricultural households (n = 6371) had a higher risk of macrosomia (aOR, 1.15; 95% CI, 1.05–1.26), large for GA (aOR, 1.12; 95% CI, 1.03–1.22), postterm birth (aOR, 1.20; 95% CI, 1.09–1.33), and low 5-minute APGAR (aOR, 1.39; 95% CI, 1.07–1.81), whereas low birth weight (aOR, 0.85; 95% CI, 0.76–0.96) and preterm birth (aOR, 0.82; 95% CI, 0.74–0.92) were inversely related.

Conclusions

Having an agriculture working parent increased the likelihood of fetal overgrowth and low APGAR.
Anal Intraepithelial Neoplasia and Anal Squamous Cell Carcinoma: Updates From the Last 3 Years
Authors: Albuquerque Andreia
Published: May 2023

In the last 3 years, new and relevant information has been published on anal cancer and anal precancerous lesions epidemiology, screening, treatment, and vaccination. This information will likely change prevention and treatment strategies for these patients in the upcoming years.
Heart Transplant Waitlist Outcomes and Wait Time by Center Volume in the Pre-2018 Allocation Change Era
Authors: Critsinelis Andre , Karamchandani Manish M. , Hironaka Camille E. , Nordan Taylor , Chen Frederick Y. , Couper Gregory S. , Kawabori Masashi
Published: May 2023

Although the transplant outcomes of centers are heavily monitored and compared, with a particular link between posttransplant outcomes and center volume demonstrated, little data exist comparing waitlist outcomes. Here, we explored waitlist outcomes by transplant center volume. We performed a retrospective analysis of adults listed for primary heart transplantation (HTx) from 2008 to 2018 using the United Network for Organ Sharing database. Transplant centers were split into low (<10 HTx/year), medium (10–30 HTx/year), and high (>30 HTx/year) volume, and waitlist outcomes were compared. Of the 35,190 patients included in our study, 23,726 (67.4%) underwent HTx, 4,915 (14.0%) died or deteriorated before receiving HTx, 1,356 (3.9%) were delisted due to recovery, and 1,336 (3.8%) underwent left ventricular assist device (LVAD) implantation. High-volume centers had higher rates of survival to transplant (71.3% vs. 60.6% for low-volume centers and 64.9% for medium-volume centers), and low rates of death or deterioration (12.6% vs. 14.6% for low-volume centers and 15.1% for medium-volume centers). Listing at a low-volume center was independently associated with death or delisting before HTx (HR 1.18, p = 0.007), whereas listing at a high-volume center (HR 0.86; p < 0.001) and prelisting LVAD (HR 0.67, p < 0.001) were protective. Death or delisting before HTx was lowest for patients listed in higher volume centers.
Neutrophil Structural and Functional Alterations After High Mechanical Shear Stress Exposure
Authors: Arias Katherin , Sun Wenji , Han Dong , Griffith Bartley P. , Wu Zhongjun J.
Published: May 2023

Patients on mechanical circulatory support are prone to infections, increasing morbidity and mortality. These circulatory support devices generate high mechanical shear stress (HMSS) that can causes trauma to blood. When leukocytes become damaged, their immune response function may be impaired or weakened, leading to increased infection vulnerability. This study examined neutrophil structural and functional alterations after exposure to 75, 125, and 175 Pa HMSS for 1 second. Human blood was exposed to three levels of HMSS using a blood shearing device. Neutrophil morphological alteration was characterized by examining blood smears. Flow cytometry assays were used to analyze expression levels of CD62L and CD162 receptors, activation level (CD11b), and aggregation (platelet-neutrophil aggregates). Neutrophil phagocytosis and rolling were examined via functional assays. The results show neutrophil structure (morphology and surface receptors) and function (activation, aggregation, phagocytosis, rolling) were significantly altered after HMSS exposure. These alterations include cell membrane damage, loss of surface receptors (CD62L and CD162), initiation of activation and aggregation, upregulation of phagocytic ability and increased rolling speed. The alterations were the most severe after 175 Pa exposure. HMSS caused damage and activation of neutrophils, potentially impairing normal neutrophil function, leading to weakened immune defense and increasing a patient’s vulnerability to infections.
Understanding the knowledge, awareness, and attitudes of the public towards liver diseases in Malaysia
Authors: Mohamed Rosmawati , Yip Christina , Singh Shikha
Published: May 2023

Background

Viral hepatitis B and C (HBV, HCV) and non-alcoholic fatty liver disease (NAFLD) are the commonest etiologies of liver-related deaths in Malaysia. Herein, this study aims to explore and understand the knowledge and attitudes of the public toward liver-related health and diseases in Malaysia.

Methods

A cross-sectional, self-reported, web-based questionnaire was conducted among 500 adults between February and March 2020. Questionnaire items pertained to the knowledge and attitudes toward liver-related health and diseases.

Results

Half of the respondents were aged ≥35 years and 52.0% were males. Gaps in knowledge included the lack of awareness of different types of hepatitis, including the potential transmission risks and complications of HBV and HCV. About half acknowledged liver fibrosis and cirrhosis as key determinants of liver-related disease progression. A higher proportion rightly recognized the diagnostic test for HCV (40.8%) than HBV (30.0%) despite more being aware of HBV than HCV. Less than one-third were aware of the risk factors, screening tests, and complications of NAFLD. Despite the majority (92.8%) agreeing that regular screening was important for liver health, only 67.0% attended recent health screening and one-fifth were unlikely to seek medical consultation upon exposure to viral hepatitis risk factors. Reasons for this low urgency included the perception of being healthy, cost-related concerns, and societal discrimination.

Conclusion

Robust education efforts are needed to raise awareness and empower the community with knowledge of liver-related diseases, particularly viral hepatitis and NAFLD in Malaysia.
Inflammatory bowel disease and atrial fibrillation: a contemporary overview
Authors: Konstantinou Christos S. , Korantzopoulos Panagiotis , Fousekis Fotios S. , Katsanos Konstantinos H.
Published: May 2023

Atrial fibrillation is the most common arrhythmia in clinical practice and it is associated with increased morbidity and mortality. Atrial fibrillation is linked with inflammatory signaling while inflammation and oxidative stress promote atrial remodeling promoting the development and perpetuation of the arrhythmia. On the other hand, inflammatory bowel disease (IBD) is considered a chronic inflammatory condition with flares and remissions. IBD has been associated with an increased risk of atherosclerotic cardiovascular disease but its relationship with atrial fibrillation has not been studied well. Recent epidemiological evidence indicates an association between IBD and atrial fibrillation, especially during flares/hospitalizations. This brief review provides a concise overview of all available data regarding the association between IBD and atrial fibrillation including the predictive role of electrocardiographic and echocardiographic markers. Several unresolved issues including the thromboembolic risk in this setting and the potential role of antiinflammatory interventions are also discussed.
Effect of elevated serum ferritin on the risk of death in patients with decompensated cirrhosis: a meta-analysis
Authors: Liu Dan , Luo Yuxin , Zheng Ya , Ji Rui , Zhou Yongning
Published: May 2023

It is still debatable whether serum ferritin is a potential prognostic marker in patients with decompensated cirrhosis. In this meta-analysis, we hope to investigate the relationship between elevated serum ferritin and the risk of death in patients with decompensated cirrhosis. We systematically searched PubMed, Embase, Web of Science, Cochrane Library, CNKI, SinoMed, WAN FANG, and ClinicalTrials.gov without language restrictions from inception to 3 October 2022, and finally identified a total of eight eligible studies with 1829 patients. The pooled prevalence of elevated serum ferritin in decompensated cirrhosis was 40.6% [95% confidence interval (CI) 32.1–49.2%], and it was higher in males, patients with alcohol-associated liver disease, those with Child–Pugh grade C, those with hepatic encephalopathy, and nonsurvivors. Nonsurvivors had significantly higher serum ferritin levels than survivors [mean difference 247.90; 95% CI, 130.97–364.84]. With a pooled unadjusted hazard ratio of 2.38 (95% CI, 1.78–3.18), high serum ferritin was associated with an increased risk of death in patients with decompensated cirrhosis, with low heterogeneity among the included studies. In conclusion, high serum ferritin levels were associated with mortality in patients with decompensated cirrhosis. More prospective and homogeneous clinical studies are required to validate our findings.
Differential Effects of an Emergency Department-to-Home Care Transitions Intervention in an Older Adult Population
Authors: Green Rebecca K. , Nieser Kenneth J. , Jacobsohn Gwen C. , Cochran Amy L. , Caprio Thomas V. , Cushman Jeremy T. , Kind Amy J.H. , Lohmeier Michael , Shah Manish N.
Published: May 2023

Background:

Older adults frequently return to the emergency department (ED) within 30 days of a visit. High-risk patients can differentially benefit from transitional care interventions. Latent class analysis (LCA) is a model-based method used to segment the population and test intervention effects by subgroup.

Objectives:

We aimed to identify latent classes within an older adult population from a randomized controlled trial evaluating the effectiveness of an ED-to-home transitional care program and test whether class membership modified the intervention effect.

Research Design:

Participants were randomized to receive the Care Transitions Intervention or usual care. Study staff collected outcomes data through medical record reviews and surveys. We performed LCA and logistic regression to evaluate the differential effects of the intervention by class membership.

Subjects:

Participants were ED patients (age 60 y and above) discharged to a community residence.

Measures:

Indicator variables for the LCA included clinically available and patient-reported data from the initial ED visit. Our primary outcome was ED revisits within 30 days. Secondary outcomes included ED revisits within 14 days, outpatient follow-up within 7 and 30 days, and self-management behaviors.

Results:

We interpreted 6 latent classes in this study population. Classes 1, 4, 5, and 6 showed a reduction in ED revisit rates with the intervention; classes 2 and 3 showed an increase in ED revisit rates. In class 5, we found evidence that the intervention increased outpatient follow-up within 7 and 30 days (odds ratio: 1.81, 95% CI: 1.13–2.91; odds ratio: 2.24, 95% CI: 1.25–4.03).

Conclusions:

Class membership modified the intervention effect. Population segmentation is an important step in evaluating a transitional care intervention.
Nurse Work Environment and Hospital-Onset Clostridioides difficile Infection
Authors: Jung Olivia S. , Aiken Linda H. , Sloane Douglas M. , Fridkin Scott K. , Li Yin , Kang Yu Jin , Becker Edmund R. , Joski Peter J. , Cimiotti Jeannie P.
Published: May 2023

Background:

Clostridioides difficile is the leading cause of hospital-onset diarrhea and is associated with increased lengths of stay and mortality. While some hospitals have successfully reduced the burden of C. difficile infection (CDI), many still struggle to reduce hospital-onset CDI. Nurses—because of their close proximity to patients—are an important resource in the prevention of hospital-onset CDI.

Objective:

Determine whether there is an association between the nurse work environment and hospital-onset CDI.

Methods:

Survey data of 2016 were available from 15,982 nurses employed in 353 acute care hospitals. These data, aggregated to the hospital level, provided measures of the nurse work environments. They were merged with 2016 hospital-onset CDI data from Hospital Compare, which provided our outcome measure—whether a hospital had a standardized infection ratio (SIR) above or below the national average SIR. Hospitals above the average SIR had more infections than predicted when compared to the national average.

Results:

In all, 188 hospitals (53%) had SIRs higher than the national average. The odds of hospitals having higher than average SIRs were significantly lower, with odds ratios ranging from 0.35 to 0.45, in hospitals in the highest quartile for all four nurse work environment subscales (managerial support, nurse participation in hospital governance, physician-nurse relations, and adequate staffing) than in hospitals in the lowest quartile.

Conclusions:

Findings show an association between the work environment of nurses and hospital-onset CDI. A promising strategy to lower hospital-onset CDI and other infections is a serious and sustained commitment by hospital leaders to significantly improve nurse work environments.