bluuebunny/crossref_metadata_2025 huggingface dataset:
Setting the Standard: Using the ABA Burn Registry to Benchmark Risk Adjusted Mortality
Authors: Mandell Samuel P , Phillips Matthew H , Higginson Sara , Hoarle Kimberly , Hsu Naiwei , Phillips Bart , Thompson Callie , Weber Joan M , Weichmann-Murata Erica , Bessey Palmer Q
Published: October 2022

Reports of single center experience and studies of larger databases have identified several predictors of burn center mortality, including age, burn size, and inhalation injury. None of these analyses has been broad enough to allow benchmarking across burn centers. The purpose of this study was to derive a reliable, risk-adjusted, statistical model of mortality based on real-life experience at many burn centers in the U.S. We used the American Burn Association 2020 Full Burn Research Dataset, from the Burn Center Quality Platform (BCQP) to identify 130,729 subjects from July 2015 through June 2020 across 103 unique burn centers. We selected 22 predictor variables, from over 50 recorded in the dataset, based on completeness (at least 75% complete required) and clinical significance. We used gradient-boosted regression, a form of machine learning, to predict mortality and compared this to traditional logistic regression. Model performance was evaluated with AUC and PR curves. The CatBoost model achieved a test AUC of 0.980 with an average precision of 0.800. The logistic regression produced an AUC of 0.951 with an average precision of 0.664. While AUC, the measure most reported in the literature, is high for both models, the CatBoost model is markedly more sensitive, leading to a substantial improvement in precision. Using BCQP data, we can predict burn mortality allowing comparison across burn centers participating in BCQP.
Semantic comparison of texts by the metric approach
Authors: Vakulenko Maksym O
Published: October 2022

A novel approach to the semantic comparison of texts based on the metric method to calculate semantic distances between lexical units is put forward. The supplementary semantic information is provided through semes of the words composing the texts, or through their semantic fields. The proposed method takes into account semantic polarity and yields, for two paraphrase sentences, more feasible results than the conventional approaches based on word occurrences. The described approach may be useful for linguistic theory as well as for a variety of Natural Language Processing tasks based on supervised learning that require semantic information: computer lexicography, semantic analysis, information search and retrieval, document classification, text summarization, and understanding machine translation and others.
The ethics of migration policy dilemmas
Authors: Bauböck Rainer , Mourão Permoser Julia , Ruhs Martin
Published: October 2022

This article proposes a new approach to the political theory of migration: the ethics of migration policy dilemmas. The core of this new approach lies in identifying specific policy dilemmas of central relevance to policy makers and other stakeholders in the field, and then submitting these dilemmas to systematic theoretical analysis. We conceptualize policy dilemmas as involving hard choices between competing moral goals and distinguish this kind of dilemma from other types of ethical choices, such as conflicting means, dirty hands, political feasibility, and politics dilemmas. We argue that, besides enlarging the range of questions asked by political theorists of migration, our approach of engaging normatively with hard policy dilemmas can help mitigate the negative political and societal effects of reductionist political positions that seek to negate the existence of competing moral goals. We make the case for a multidisciplinary approach to the normative analysis of hard ethical dilemmas, transcending both explanatory and interpretive analyses in the spirit of an applied normative political theory that aims to be action guiding.
The first photometric and orbital period investigation of an extremely low mass ratio contact binary with a sudden period change TYC 4002-2628-1
Authors: Guo Di-Fu , Li Kai , Liu Fen , Li Huai-Zhen , Xia Qi-Qi , Gao Xing , Gao Xiang , Chen Xu , Gao Dong-Yang , Sun Guo-You
Published: October 2022

Photometric observations for the totally eclipsing binary system TYC 4002-2628-1, were obtained between November 2020 and November 2021. To determine the stellar atmospheric parameters, a spectral image was taken with the 2.16 m telescope at National Astronomical Observatory of China (NAOC). TYC 4002-2628-1 is a low-amplitude (about 0.15 mag for Vband) short-period (0.3670495 d) contact eclipsing binary with a total secondary eclipse. Intrinsic light curve variations and the reversal of the O’Connell effect are detected in the light curves, which may be due to spot activity. Based on the photometric solutions derived from the multiband time series light curves, TYC 4002-2628-1 is an extremely low-mass ratio contact binary with a mass ratio of q ∼ 0.0482 and a fill-out factor of $f\sim 5{{\ \rm per\ cent}}$. By analysing the O− C variations, we find that its orbital period remains unchanged when BJD < 2458321. Then the orbital period changed suddenly around BJD 2458743 and has an increasing rate of $\mathrm{ d}P/\mathrm{ d}t=1.62\times {10^{-5}}\,\mathrm{ d}\cdot \mathrm{ yr}^{-1}=140\, \mathrm{ s}\cdot \mathrm{ century}^{-1}$. If confirmed, TYC 4002-2628-1 would be the contact binary with the highest orbital period increasing rate so far. By investigating the ratio of orbital angular momentum to the spin angular momentum (Jorb/$J_{\mathrm{ spin}}\, \lt\, 3$), the instability mass ratio (qinst/q = 1.84) and the instability separation (Ainst/A = 1.35), TYC 4002-2628-1 can be regarded as a merger candidate.
Distance and age of the massive stellar cluster Westerlund 1 – II. The eclipsing binary W36
Authors: Rocha Danilo F , Almeida Leonardo A , Damineli Augusto , Navarete Felipe , Abdul-Masih Michael , Mace Gregory N
Published: October 2022

Westerlund 1 (Wd 1) is one of the most relevant star clusters in the Milky Way to study massive star formation, although it is still poorly known. Here, we used photometric and spectroscopic data to model the eclipsing binary W36, showing that its spectral type is O6.5 III  +  O9.5 IV, hotter and more luminous than thought before. Its distance dW36 = 4.03 ± 0.25 kpc agrees, within the errors, with three recent Gaia-EDR3-based distances reported in Paper I, Beasor & Davies, and by Negueruela’s group. However, they follow different approaches to fix the zero-points for red sources such as those in Wd 1, and to select the best approach, we used an accurate modelling of W36. The weighted mean distance of our parallax (Paper I) and binary distances results in dwd1 = 4.05 ± 0.20 kpc, with an unprecedented accuracy of 5 per cent. We adopted isochrones based on the Geneva code with supersolar abundances to infer the age of W36B as 6.4 ± 0.7 Myr. This object seems to be part of the prolific star formation burst represented by OB giants and supergiants that occurred at 7.1 ± 0.5 Myr ago, which coincides with the recently published PMS isochrone with age 7.2 Myr. Other BA-type luminous evolved stars and yellow hypergiants spread in the age range of 8–11 Myr. The four red supergiants discussed in paper I represent the oldest population of the cluster with an age of 10.7 ± 1 Myr. The multiple episodes of star formation in Wd 1 are reminiscent of that reported for the R136/30 Dor LMC cluster.
Association between the patterns of large-vessel lesions and treatment outcomes in patients with large-vessel giant cell arteritis
Authors: Sugihara Takahiko , Uchida Haruhito A , Yoshifuji Hajime , Maejima Yasuhiro , Naniwa Taio , Katsumata Yasuhiro , Okazaki Takahiro , Ishizaki Jun , Murakawa Yohko , Ogawa Noriyoshi , Dobashi Hiroaki , Horita Tetsuya , Tanaka Yoshiya , Furuta Shunsuke , Takeuchi Tsutomu , Komagata Yoshinori , Nakaoka Yoshikazu , Harigai Masayoshi
Published: October 2022

Objectives

We aimed to identify associations between patterns of large-vessel lesions of large-vessel giant cell arteritis (LV-GCA) and treatment outcomes.

Methods

We extracted data on 68 newly diagnosed patients with LV-GCA from a retrospective, multi-centric, nationwide registry of GCA patients treated with glucocorticoids between 2007 and 2014. Patients with aortic lesions were identified based on the findings from contrast-enhanced computed tomography, magnetic resonance imaging, or positron emission tomography–computed tomography (Group 2, n = 49). Patients without aortic lesions were subdivided into LV-GCA with or without subclavian lesions defined as Group 1 (n = 9) or Group 3 (n = 10), respectively. The primary outcome evaluation was failure to achieve clinical remission by Week 24 and/or relapse within 104 weeks.

Results

The mean age and proportion of patients with cranial lesions and polymyalgia rheumatica in Group 2 were numerically lower than in the other two groups. Large-vessel lesions in Group 3 included carotid, pulmonary, renal, hepatic, or mesenteric lesions. The cumulative rate of poor treatment outcomes >2 years was 11.1%, 55.3%, and 88.0% in Groups 1, 2, and 3, respectively (by Kaplan–Meier analysis). The mean time to poor outcome was significantly different between the groups.

Conclusions

Classification by subclavian and aortic lesions may be useful to determine treatment strategy.
Beyond the veil of duality—topographic reorganization model of meditation
Authors: Cooper Austin Clinton , Ventura Bianca , Northoff Georg
Published: October 2022

Meditation can exert a profound impact on our mental life, with proficient practitioners often reporting an experience free of boundaries between a separate self and the environment, suggesting an explicit experience of “nondual awareness.” What are the neural correlates of such experiences and how do they relate to the idea of nondual awareness itself? In order to unravel the effects that meditation has on the brain’s spatial topography, we review functional magnetic resonance imaging brain findings from studies specific to an array of meditation types and meditator experience levels. We also review findings from studies that directly probe the interaction between meditation and the experience of the self. The main results are (i) decreased posterior default mode network (DMN) activity, (ii) increased central executive network (CEN) activity, (iii) decreased connectivity within posterior DMN as well as between posterior and anterior DMN, (iv) increased connectivity within the anterior DMN and CEN, and (v) significantly impacted connectivity between the DMN and CEN (likely a nonlinear phenomenon). Together, these suggest a profound organizational shift of the brain’s spatial topography in advanced meditators—we therefore propose a topographic reorganization model of meditation (TRoM). One core component of the TRoM is that the topographic reorganization of DMN and CEN is related to a decrease in the mental-self-processing along with a synchronization with the more nondual layers of self-processing, notably interoceptive and exteroceptive-self-processing. This reorganization of the functionality of both brain and self-processing can result in the explicit experience of nondual awareness. In conclusion, this review provides insight into the profound neural effects of advanced meditation and proposes a result-driven unifying model (TRoM) aimed at identifying the inextricably tied objective (neural) and subjective (experiential) effects of meditation.
The Impact of the COVID-19 Pandemic on Smoking, Vaping, and Smoking Cessation Services in the United Kingdom: A Qualitative Study
Authors: Johnston Emily , Bains Manpreet , Hunter Abby , Langley Tessa
Published: October 2022

Background

Existing evidence suggests that while the coronavirus disease 2019 (COVID-19) pandemic triggered quit attempts among many smokers, it led some to smoke more and others to relapse back to smoking. These diverse effects have the potential to have a long-term impact on individuals’ smoking and vaping behaviors.

Aims and Methods

This study explored the effect of COVID-19 on smokers and vapers, vape shops (VS), and stop smoking services (SSS). A total of 39 semi-structured interviews were conducted with stop-smoking practitioners, tobacco control leads, smokers and/or vapers, and vape shop owners. Interviews were transcribed verbatim and analyzed thematically.

Results

Four themes were identified: Lockdown as a barrier to becoming or remaining smoke-free; COVID as a catalyst for quitting and remaining smoke-free; changes in vaping and challenges for vapers and VS; and changes and challenges for stop smoking support. Fear of COVID resulting in severe health implications for smokers facilitated behavior change; however, the boredom and monotony of lockdown and associated stress created difficulties in remaining a smoke free. Results showed that the enforced switch from face-to-face to the remote provision of SSS was beneficial for improving engagement, particularly for vulnerable groups such as pregnant women. Stop smoking professionals and vapers disagreed with the forced closure of VS because it created unnecessary difficulties for vapers to access supplies.

Conclusions

COVID-19 was both a barrier and facilitator for smoking cessation. Remote provision of SSS implemented due to lockdown was beneficial for hard-to-reach groups; services should look to incorporate these changes into day-to-day practice.

Implications

This study is one of the first to explore how the COVID-19 pandemic directly affected smokers, vapers, SSS, tobacco control leads, and VS. It provides evidence for the continued use of the remote provision of smoking cessation services to increase engagement among hard-to-reach groups and provides information on how pandemics can be a catalyst for health behavior change. This study is unique in that it incorporates the views of different stakeholders.
Change in the Perception of Oral Antibiotics Among Medical Students After Participating in a Parenteral-to-Oral Conversion Program for Highly Bioavailable Antibiotics
Authors: Jang Wooyoung , Pai Hyunjoo , Kim Bongyoung
Published: October 2022

Background

Appropriate conversion of antibiotics from a parenteral to the oral route can lower the risk of catheter-associated infections, reduce medical costs, and shorten hospitalization. This study investigated the effect of a parenteral-to-oral conversion program for highly bioavailable antibiotics on the perceptions of medical students regarding oral antibiotics.

Methods

In 2021, the parenteral-to-oral conversion program was implemented as one of the activities of an antimicrobial stewardship program at a tertiary-care hospital in South Korea. This program was also implemented for fifth-year medical students in the hospital's infectious diseases department as a core clinical practice course. Medical students reviewed the medical records of patients taking antibiotics with a high oral bioavailability and wrote a recommendation for oral conversion after confirmation by an infectious disease specialist. A survey on the perception of oral antibiotics was administered to medical students before and after clinical practice to evaluate the educational effect of the program.

Results

A total of 923 cases were reviewed, and more than one-fifth of the antibiotics with a high oral bioavailability were administered parenterally despite their oral conversion (20.6%, 190/923). Of these, 24.2% (46/190) accepted the written proposal within 48 hours, and 43.7% (83/190) declined the proposal. Through this program, students gained a proper perception of oral antibiotics.

Conclusions

The parenteral-to-oral conversion program demonstrated an acceptance rate of oral antibiotic conversion in the hospital of 24.2% and had significant educational benefits for medical students, giving them the ability to construct an appropriate perception of oral antibiotics.
Demystifying Legal Personhood for Non-Human Entities: A Kelsenian Approach
Authors: Buocz Thomas , Eisenberger Iris
Published: October 2022

This article aims to show that minimalist theories of legal personhood are particularly well suited to evaluating legal personhood proposals for non-humans. It adopts the perspective of Hans Kelsen’s theory of legal personhood, which reduces legal persons to bundles of legal norms. Through the lens of Kelsen’s theory, the article discusses two case studies: legal personhood for natural features in New Zealand and legal personhood for robots in the EU. While the New Zealand case was an acclaimed success, the EU’s proposal was heavily criticised and eventually abandoned. The article explains these widely differing outcomes by highlighting the relevant legal norms and their addressees rather than legal personhood itself. It does so by specifying the rights and obligations that constitute the legal persons, by preventing the attribution of any other rights and obligations to these persons and, finally, by tracing who is ultimately addressed by the relevant rights and obligations.
Characterization of the Functions of Starch Synthase IIIb Expressed in the Vegetative Organs of Rice (Oryza sativa L.)
Authors: Morita Ryutaro , Crofts Naoko , Miura Satoko , Ikeda Ken-ichi , Aoki Naohiro , Fukayama Hiroshi , Fujita Naoko
Published: October 2022

Rice is the model C3 crop for investigating the starch biosynthesis mechanism in endosperm because of its importance in grain production. However, little is known about starch biosynthesis in the vegetative organs of rice. In this study, we used novel rice mutants by inserting Tos17 into the starch synthase (SS) IIIb gene, which is mainly expressed in the leaf sheath (LS) and leaf blade (LB), and an ss1 mutant to clarify the differences in roles among SS isozymes during starch biosynthesis. Native polyacrylamide gel electrophoresis (PAGE)/activity staining for SS, using LS and LB of ss mutants, revealed that the lowest migrating SS activity bands on the gel were derived from SSIIIb activity and those of two ss3b mutants were not detected. The apparent amylose content of LS starch of ss3b mutants increased. Moreover, the chain-length distribution and size-exclusion chromatography analysis using ss mutants showed that SSIIIb and SSI synthesize the B2–B3 chain and A–B1 chain of amylopectin in the LS and LB respectively. Interestingly, we also found that starch contents were decreased in the LS and LB of ss3b mutants, although SSI deficiency did not affect the starch levels. All these results indicated that SSIIIb synthesizes the long chain of amylopectin in the LS and LB similar to SSIIIa in the endosperm, while SSI synthesizes the short chain in the vegetative organ as the same in the endosperm.
Autoimmune activation and hypersensitization of the AT1 and ETA receptors contributes to vascular injury in scleroderma renal crisis
Authors: Hegner Björn , Kretzschmar Tobias , Zhu Nan , Kleinau Gunnar , Zhao Hongfan , Kamhieh-Milz Julian , Hilger Julia , Schindler Ralf , Scheerer Patrick , Riemekasten Gabriela , Philippe Aurélie , Catar Rusan
Published: October 2022

Objectives

Scleroderma renal crisis (SRC) is a rare vascular complication of systemic sclerosis with substantial risks for end-stage renal disease and premature death. Activating autoantibodies (Abs) targeting the angiotensin II type 1 (AT1R) and the endothelin-1 type A receptor (ETAR) have been identified as predictors for SRC. Here, we sought to determine their pathogenic significance for acute renal vascular injury potentially triggering kidney failure and malignant hypertension.

Methods

IgG from patients with SRC was studied for AT1R and ETAR dependent biologic effects on isolated rat renal interlobar arteries and vascular cells including contraction, signalling and mechanisms of receptor activation.

Results

In myography experiments, patient IgG exerted vasoconstriction sensitive to inhibition of AT1R and ETAR. This relied on MEK-ERK signalling indicating functional relevance of anti-AT1R and anti-ETAR Abs. The contractile response to angiotensin II and endothelin-1 was amplified by patient IgG containing anti-AT1R and anti-ETAR Abs with substantial crosstalk between both receptors implicating autoimmune receptor hypersensitization. Co-immunoprecipitation experiments indicated heterodimerization between both receptor types which may enable the observed functional interrelation by direct structural interactions.

Conclusion

We provide experimental evidence that agonistic Abs may contribute to SRC. This effect is presumably related to direct receptor stimulation and additional allosteric effects, at least in heterodimeric receptor constellations. Novel therapies targeted at autoimmune hyperactivation of AT1R and ETAR might improve outcomes in severe cases of SRC.
Predicting human cardiac QT alterations and pro-arrhythmic effects of compounds with a 3D beating heart-on-chip platform
Authors: Visone Roberta , Lozano-Juan Ferran , Marzorati Simona , Rivolta Massimo Walter , Pesenti Enrico , Redaelli Alberto , Sassi Roberto , Rasponi Marco , Occhetta Paola
Published: October 2022

Determining the potential cardiotoxicity and pro-arrhythmic effects of drug candidates remains one of the most relevant issues in the drug development pipeline (DDP). New methods enabling to perform more representative preclinical in vitro studies by exploiting induced pluripotent stem cell-derived cardiomyocytes (iPSC-CM) are under investigation to increase the translational power of the outcomes. Here we present a pharmacological campaign conducted to evaluate the drug-induced QT alterations and arrhythmic events on uHeart, a 3D miniaturized in vitro model of human myocardium encompassing iPSC-CM and dermal fibroblasts embedded in fibrin. uHeart was mechanically trained resulting in synchronously beating cardiac microtissues in 1 week, characterized by a clear field potential (FP) signal that was recorded by means of an integrated electrical system. A drug screening protocol compliant with the new International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines was established and uHeart was employed for testing the effect of 11 compounds acting on single or multiple cardiac ion channels and well-known to elicit QT prolongation or arrhythmic events in clinics. The alterations of uHeart’s electrophysiological parameters such as the beating period, the FP duration, the FP amplitude, and the detection of arrhythmic events prior and after drug administration at incremental doses were effectively analyzed through a custom-developed algorithm. Results demonstrated the ability of uHeart to successfully anticipate clinical outcome and to predict the QT prolongation with a sensitivity of 83.3%, a specificity of 100% and an accuracy of 91.6%. Cardiotoxic concentrations of drugs were notably detected in the range of the clinical highest blood drug concentration (Cmax), qualifying uHeart as a fit-to-purpose preclinical tool for cardiotoxicity studies.
Blunt chest wall trauma
Authors: Beloy Victoria , Dull Matthew
Published: October 2022

Blunt injuries to the chest wall, specifically those related to rib fractures, need to be promptly identified and effectively managed to reduce patient morbidity and mortality. Furthermore, judicious use of multimodal pain management and early identification of patients who will benefit from the surgical stabilization of rib fractures are paramount to optimal outcomes.
Single Site Experience of the use of Monoclonal Antibodies for the Treatment of COVID-19 in High-risk Pediatric and Young Adult Patients
Authors: Bahakel Hannah , Murphy Catherine , Frenck Robert W. , Grimley Michael S. , Marsh Rebecca A. , Paulsen Grant C. , Haslam David B. , Phillips Christine L. , Courter Joshua , Spearman Paul , Schulert Grant , Danziger-Isakov Lara
Published: October 2022

Background:

Effective therapeutic agents for the treatment of COVID-19 have been investigated since the onset of the pandemic. Monoclonal antibodies targeting the spike protein of SARS-CoV-2 have been developed for the treatment of mild or moderate COVID disease in high-risk populations. Despite widespread use in the adult population, data are limited on the safety and efficacy of monoclonal antibody infusions in the adolescent and young adult population.

Methods:

Patients who received bamlanivimab, bamlanivimab-etesevimab, casirivimab-imdevimab, or sotrovimab for treatment of mild-to-moderate COVID-19 disease at Cincinnati Children’s Hospital Medical Center from 5/1/2020 to 3/1/2022 were identified retrospectively. Patient data including demographics, adverse events, and outcomes were extracted from patients’ charts and summarized by standard descriptive summaries.

Results:

Ninety-four patients received monoclonal antibody therapy, of which 14 (14.9%) received either bamlanivimab or bamlanivimab-etesevimab, 54 (57.4%) received casirivimab-imdevimab, and 26 (27.6%) received sotrovimab. Ten patients (10.6%) experienced one or more infusion-related adverse event. Of the patients who experienced adverse events, all resolved with cessation of infusion. No life-threatening events or deaths occurred. Within 90 days of receiving a monoclonal antibody, 12 patients (12.7%) required additional medical care for ongoing COVID symptoms. Five of these were either hospitalized or received escalation of care while already in the hospital. All subsequently fully recovered. Neither infusion-related adverse events nor progression to hospitalization for ongoing COVID-19 symptoms following monoclonal antibody administration were associated with any particular underlying condition.

Conclusions:

Overall, monoclonal antibodies are reasonably well-tolerated COVID-19 therapies in high-risk adolescent and young adult populations.
Preconception health optimization in women with polycystic ovary syndrome − how to find the time?
Authors: Lennon Clare , Voss Kathryn , Vitek Wendy S.
Published: October 2022

Purpose of review

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among reproductive-age women, the most common cause of infertility among women and a major contributor to pregnancy complications.

Recent findings

Diagnostic and associated features of PCOS, including hyperandrogenism, insulin resistance, and obesity, contribute to the 2−4-fold increased risk of pregnancy-induced hypertension and preeclampsia, gestational diabetes and preterm birth observed among pregnant women with PCOS. PCOS should be diagnosed according to the 2018 International Guideline. Screening for and optimizing management of hypertension, impaired glucose tolerance and obesity in the preconception window in women with PCOS provides an opportunity to increase the odds of a spontaneous pregnancy, live birth with fertility treatment and possibly reduce the risk of pregnancy complications.

Providers should prioritize individualizing recommendations for preconception health optimization in women with PCOS in order to maximize the chance of conception, a healthy pregnancy and the health of future generations.
NUT Carcinoma in Children and Adolescents: The Expert European Standard Clinical Practice Harmonized Recommendations
Authors: Lemelle Lauriane , Flaadt Tim , Fresneau Brice , Moya-Plana Antoine , Timmermann Beate , Roganovic Jelena , Ferrari Andrea , Fichera Giulia , Lauer Ulrich M. , Ben-Ami Tal , Schneider Dominik T. , Vokuhl Christian , Bolle Stephanie , Fox Elisabeth , DuBois Steven G. , Rodriguez-Galindo Carlos , Bisogno Gianni , Surun Aurore , Brecht Ines B. , Orbach Daniel
Published: October 2022

Background and Aims:

Nuclear protein of the testis (NUT) carcinoma (NC) is a rare and highly aggressive tumor mainly occurring in adolescents and young adults, defined by the presence of a somatic NUTM1 rearrangement. The aim is to establish internationally harmonized consensus recommendations for the diagnosis and treatment of adolescents and young adults with NC in the framework of the European Reference Network for Paediatric Oncology.

Methods:

The European Cooperative Study Group for Pediatric Rare Tumors developed recommendations according to the Consensus Conference Standard Operating procedure methodology and reviewed by external “experts.” No evidence of level I to II exists. Recommendations were developed based on published prospective (level III), but more frequently retrospective series (level IV), case reports (level V), and personal expertise (level V). In addition, “strength” of recommendations were categorized by grading (grade A to E).

Results:

Histology is mandatory for the diagnosis of NC, including immunolabeling with anti-NUT antibodies and molecular biology (NUTM1 rearrangement) (level V; grade A). Treatment of NC usually combines aggressive approaches in multimodal regimens. Chemotherapy should be considered as first-line treatment (neoadjuvant vincristine-adriamycin-ifosfamide/cisplatin-adriamycin-ifsofamide or vincristine-doxorubicin-cyclophosphamide/ifosfamide-etoposide) for unresectable or metastatic tumor (ie, 3 courses), rapidly followed by local treatment (level IV; grade B). Referral to a specialized surgical oncology center is highly recommended (level V; grade A). In localized NC, a complete microscopic surgical resection should be attempted whenever and as soon as possible, followed by primary irradiation (60 to 70 Gy) and involved lymph nodes area (level IV; grade B). For head and neck tumors, a systematic neck dissection might be considered, even if N0 (level V; grade C). Adjuvant postirradiation chemotherapy is recommended, for a total of 9 to 12 courses (level IV; grade B). For first-line resected tumors, concomitant adjuvant chemotherapy to radiotherapy may be discussed (level IV; grade B). Targeted therapies and immunotherapeutic regimens should be delivered in the setting of prospective trials (level V; grade B).

Conclusions:

This project leads to a consensus strategy based on international experience with this very rare disease.
It Is Not Just the Southeast—Geographically Pervasive Racial Disparities in Neisseria gonorrhoeae Between Non-Hispanic Black and White US Women
Authors: Rowlinson Emily , Stenger Mark R. , Valentine Jo A. , Hughes James P. , Khosropour Christine M. , Golden Matthew R.
Published: October 2022

Racial disparities in female gonorrhea rates are not confined to the Southeast; both relative and absolute disparities are equivalent or larger in areas of the Northeast, Midwest, and West.

Background

Spatial analyses of gonorrhea morbidity among women often highlight the Southeastern United States but may not provide information on geographic variation in the magnitude of racial disparities; such maps also focus on geographic space, obscuring underlying population characteristics. We created a series of visualizations depicting both county-level racial disparities in female gonorrhea diagnoses and variations in population size.

Methods

We calculated county- and region-level race-specific relative rates (RelR) and between-race rate differences (RDs) and rate ratios (RRs) comparing gonorrhea case rates in non-Hispanic Black (NHB) versus non-Hispanic White (NHW) women. We then created proportional symbol maps with color representing counties' RelR/RD/RR category and symbol size representing counties' female population.

Results

Gonorrhea rates among NHB women were highest in the Midwest (718.7/100,000) and West (504.8), rates among NHW women were highest in the West (74.1) and Southeast (72.1). The RDs were highest in the Midwest (654.6 excess cases/100,000) and West (430.7), whereas the RRs were highest in the Northeast (12.4) and Midwest (11.2). Nearly all US counties had NHB female rates ≥3× those in NHW women, with NHB women in most highly populated counties experiencing ≥9-fold difference in gonorrhea rates.

Conclusions

Racial disparities in gonorrhea were not confined to the Southeast; both relative and absolute disparities were equivalent or larger in magnitude in areas of the Northeast, Midwest, and West. Our findings help counter damaging regional stereotypes, provide evidence to refocus prevention efforts to areas of highest disparities, and suggest a useful template for monitoring racial disparities as an actionable public health metric.
Iodinated Contrast Enhancement of Breast Cancer on Prone Multidetector Computed Tomography—Preliminary Findings
Authors: Felipe Vinicius C. , Barbosa Paula N.V.P. , Chojniak Rubens , Bitencourt Almir G.V.
Published: October 2022

Objectives

Contrast-enhanced breast imaging has gained increasing importance in the diagnosis and management of breast cancer. The aim of this study was to assess breast cancer enhancement after contrast administration on prone multidetector computed tomography (MDCT).

Materials and Methods

This retrospective, unicentric, institutional review board-approved study included patients with newly diagnosed breast cancer who were submitted to contrast-enhanced MDCT in prone position, with image acquisition before and after nonionic iodinated contrast administration.

Results

Sixty breast cancer patients aged between 31 and 74 years (mean, 49 years) were included. Most patients (n = 50, 83.3%) had no special type invasive breast carcinoma and luminal subtype (n = 45, 75%). All index breast tumors were identified on prone MDCT. Forty-three cases (70.5%) presented as mass, 13 (21.3%) as nonmass enhancement and 4 (6.6%) as both mass and nonmass enhancement. Mean tumor density was 37.8 HU and 87.9 HU on precontrast and postcontrast images, respectively. Mean contrast enhancement was 50.2 HU (range, 20–109 HU). There were no statistically significant differences in tumor enhancement according to histological type, molecular subtype, nuclear grade, tumor size, or imaging presentation.

Conclusions

Our results show that breast cancer usually can be identified and have significant contrast enhancement on prone MDCT images. This method could be used as an alternative when other contrast-enhanced breast imaging methods are not available.
Which Body Composition Parameters on Computed Tomography Are More Successful in Predicting the Prognosis of COVID-19 Patients?
Authors: Ufuk Furkan , Utebey Ayse Ruksan , Yavas Huseyin Gokhan , Baser Oncel Sevin , Akbudak Ismail Hakki , Sari Tugba
Published: October 2022

Objectives

The aims of the study are to compare the body composition parameters (BCPs), which have been reported to have a prognostic impact, in COVID-19 patients, and to determine the most influential BCP(s) on the prognosis.

Methods

Unenhanced chest computed tomography examinations of COVID-19 cases were assessed regarding the severity of pneumonia, pectoralis muscle area and density (PMA, PMD), visceral adipose tissue area (VAA), waist circumference, waist to paravertebral muscle circumference ratio, coronary artery calcification severity, and paravertebral muscle area at the T5 vertebral level. A second observer repeated measurements and an intraclass correlation coefficient score were used for interobserver agreement. The relationship between data and patient outcomes (intubation, death) was investigated using multivariable logistic regression analysis. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of BCPs in predicting outcomes.

Results

A total of 238 (121 males, median age, 48 years [interquartile range, 36–63 years]) consecutive COVID-19 patients with chest computed tomography were investigated. Twenty-four patients (10.08%) were intubated, and 15 patients (6.3%) died during at least 1 month of follow-up. Waist to paravertebral muscle circumference ratio, PMA, PMD, and T5 vertebral level were significantly associated with intubation in the multivariable analysis. Pectoralis muscle density and PMA were significantly associated with death. Pectoralis muscle density showed the highest AUC for the prediction of intubation and death (AUC of 0.814 and 0.871, respectively). There was a good to excellent agreement between observers (intraclass correlation coefficient range, 0.899–0.998).

Conclusions

Pectoralis muscle density is the most influential BCP in predicting intubation and death in COVID-19 patients.
Optimizing Flap Harvest in Auricular Reconstruction
Authors: Fernando Shanik J. , Davis Seth J. , Dedhia Raj D. , Sowder Justin C. , Ramachandra Tara , Stephan Scott J.
Published: October 2022

Introduction:

The temporoparietal fascial (TPF) and occipital cranial fascial (OCP) flaps are the mainstay of implant coverage in alloplastic auricular reconstruction. Their optimal design is critical for elevating a robust flap that ultimately leads to favorable outcomes.

Materials and Methods:

Sixteen TPF and OCP dissections were performed on 8 cadaveric specimens. Vascular anatomy and key landmarks were documented. The minimum flap size that incorporated ideal vasculature and would appropriately cover a porous polyethylene implant was measured.

Results:

The minimum flap dimensions (length × width × base width) to cover a standard PPE auricular implants were on average 11×8.3×6.4 cm for TPF and 13.1×8.6×6.5 cm for OCP. The average axial length of the superficial temporal artery and occipital artery were 12.51 and 13.2 cm, respectively. An “occipital elbow” was located on average 8.2 cm posterior to the external acoustic canal. The postauricular fascia contained additional contributions from the occipital artery and mastoid emissary vein, which was located on average 5.9 cm posterior to the superficial temporal artery.

Conclusions:

This study highlights the anatomic features behind optimal TPF and OCP flap design for auricular reconstruction. Contributions to axial length and anatomic relationships of their primary arterial supply, significance of the occipital elbow as a reliable landmark for fascial dissection, and importance of the postauricular fascia and its vascular supply for flap viability are emphasized. Ultimately, the authors provide minimal dimensions for both TPF and OCP flaps to obtain adequate alloplastic implant coverage.
Surgical Management of Hypertelorism: The 3D Animated Technical Note
Authors: Kulker Dimitri , Louisy Agathe , Listrat Antoine , Travers Nadine , Pare Arnaud , Laure Boris
Published: October 2022

The hypertelorism surgery is a complex procedure requiring a long learning curve. Even though the box osteotomy technique is well described in literature, its representation is generally based on texts and illustrations that do not really give a 3-dimensional or a dynamic point of views. The authors present a 3-dimensional animated video, Supplemental Digital Content 1, http://links.lww.com/SCS/E561 showing the craniofacial osteotomies and focusing on the critical points to correct hypertelorism.
Reconstructive Operation of Severe Orbital Hypertelorism With Computer-Assisted Precise Virtual Plan
Authors: Ouyang Long , Li Binghang , Xu Shixing , Jin Qi , Chen Ying , Gui Lai , Fu Jidi , Niu Feng
Published: October 2022

Orbital hypertelorism correction is still a less precise procedure, with a simple preoperative design and surgical results often depending on the operator’s experience. In recent years, computer-assisted technology has been fully utilized in craniofacial surgery. This article aims to explore the clinical results of computer-assisted technology in orbital hypertelorism correction and discuss its advantages and effects on treatment. Four patients with orbital hypertelorism underwent intracranial and extracranial combined box osteotomy correction. Preoperative computed tomography scans were performed, and 3-dimensional 3D digital technology was used to measure the orbital spacing, virtually design the 3D cutting scheme, and guide the intraoperative 3D cutting to improve the accuracy of periorbital osteotomy and reduce the surgical risk. Four patients underwent successful surgery, and the average distance of the medial orbital wall was decreased from 43.6 to 23.4 mm. Computer-assisted box osteotomy shortens the operative time and provides better corrective results.
Limited Access to Alveolar Bone Graft Surgery Following Primary Cleft Lip and Palate Repair in Indonesia: A Questionnaire-Based Qualitative Study
Authors: Bangun Kristaninta , Halim Jessica , Tania Vika , Kreshanti Prasetyanugraheni , Pancawati Julieta , Atmodiwirjo Parintosa
Published: October 2022

Introduction:

Cleft Lip and Palate is the most common craniofacial anomaly, and cleft lip and palate repair is widely performed. Alveolar cleft accompanies 75% of cleft lip cases and requires alveolar bone graft (ABG) surgery at mixed dentition age. However, studies on rates of ABG surgery are scarce.

Objective:

This study aims to investigate the low popularity of ABG and orthodontic care among patients with ABG history at Cleft and Craniofacial Centre, Cipto Mangunkusumo Hospital, Jakarta.

Method:

A total of 771 patients had orofacial cleft surgeries throughout 2015 to 2021. A descriptive analysis of labioplasty, palatoplasty, and ABG surgeries was presented. Questionnaire-based qualitative analysis of ABG was obtained from the patient’s guardians to evaluate the limitation and experience of conducting the surgery at our institution.

Results:

We distributed questionnaires to 13 patients with a history of ABG. ABG accounted for only 5% of total orofacial cleft surgeries. The average age of ABG surgery and orthodontic care initiation was 11 and 11.8 years old, respectively. About 82% had access to preoperative and postoperative orthodontic care; however, only 11% received PSO before 9 years old. The satisfaction rate was 100% and 75% in ABG patients with and without orthodontic care, respectively, reporting improved feeding, speech, teeth alignment, and esthetic result.

Conclusion:

Orofacial cleft management requires a multistage, comprehensive, and multidisciplinary approach. The number of ABG surgeries is low in developing countries, attributed to unequal access to ABG and orthodontic care, suggesting that limitations of knowledge, geography, and economy play a big role in Indonesian healthcare.
Psychophysiologic symptom relief therapy (PSRT) for post-acute sequelae of COVID-19: a non-randomized interventional study
Authors: Donnino Michael , Howard Patricia , Mehta Shivani , Silverman Jeremy , Cabrera Maria J , Yamin Jolin B , Balaji Lakshman , Tolin Rebecca , Berg Katherine M , Edwards Robert , Grossestreuer Anne V
Published: October 2022

Objective

To determine if psychophysiologic symptom relief therapy (PSRT) will reduce symptom burden in patients suffering from post-acute sequelae of COVID-19 (PASC) who had mild/moderate acute COVID-19 disease without objective evidence of organ injury.

Patients and Methods

Twenty-three adults under the age of 60 with PASC for at least 12 weeks following COVID-19 infection were enrolled in an interventional cohort study conducted via virtual platform between May 18, 2021 and August 7, 2022. Participants received PSRT during a 13 week (approximately 44 hour) course. Participants were administered validated questionnaires at baseline and at 4, 8, and 13 weeks. The primary outcome was change in somatic symptoms from baseline, measured using the Somatic Symptom Scale-8 (SSS-8).

Results

The median duration of symptoms prior to joining the study was 267 days (IQR: 144, 460). The mean SSS-8 score of the cohort decreased from baseline by 8.5 (95% CI: 5.7-11.4), 9.4 (95% CI: 6.9-11.9), and 10.9 (95% CI: 8.3-13.5) at 4, 8, and 13 weeks respectively (all p<0.001). Participants also experienced statistically significant improvements across secondary outcomes including changes in dyspnea, fatigue, and pain (all p<0.001).

Conclusion

PSRT may effectively decrease symptom burden in patients suffering from PASC without evidence of organ injury. The study was registered onclinicaltrials.gov(NCT 04854772).
A method for estimating causal effects from heterogeneous clinical trials without a common control group using sequential regression and simulation: an individual participant data meta-analysis and validation study
Authors: Rudrapatna Vivek A. , Ravindranath Vignesh G. , Arneson Douglas V. , Mosenia Arman , Butte Atul J. , Wang Shan
Published: October 2022

BACKGROUND

The advent of clinical trial data sharing platforms has created opportunities for making new discoveries and answering important questions using already collected data. However, existing methods for meta-analyzing these data require the presence of shared control groups across studies, significantly limiting the number of questions that can be confidently addressed. We sought to develop a method for meta-analyzing potentially heterogeneous clinical trials even in the absence of a common control group.

METHODS

This work was conducted within the context of a broader effort to study comparative efficacy in Crohn’s disease. Following a search ofclnicaltrials.govwe obtained access to the individual participant data from nine trials of FDA-approved treatments in Crohn’s Disease (N=3392). We developed a method involving sequences of regression and simulation to separately model the placebo- and drug-attributable effects, and to simulate head-to-head trials against an appropriately normalized background. We validated this method by comparing the outcome of a simulated trial comparing the efficacies of adalimumab and ustekinumab against the recently published results of SEAVUE, an actual head-to-head trial of these drugs. This study was pre-registered on PROSPERO (#157827) prior to the completion of SEAVUE.

FINDINGS

Using our method of sequential regression and simulation, we compared the week eight outcomes of two virtual cohorts subject to the same patient selection criteria as SEAVUE and treated with adalimumab or ustekinumab. Our primary analysis replicated the corresponding published results from SEAVUE (p=0·9). This finding proved stable under multiple sensitivity analyses.

INTERPRETATION

This new method may help reduce the bias of individual participant data meta-analyses, expand the scope of what can be learned from these already-collected data, and reduce the costs of obtaining high-quality evidence to guide patient care.

FUNDING

NIH; UCSF Division of Gastroenterology and Bakar Computational Health Sciences Institute; University of San Francisco