bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Elevated NT-proBNP and its Prognostic Value by Blood Pressure Treatment and Control
Authors: Daya Natalie R , McEvoy John W , Christenson Robert H , Tang Olive , Foti Kathryn , Juraschek Stephen P , Selvin Elizabeth , Echouffo-Tcheugui Justin B
Published: July 2023

BACKGROUND

The prognostic utility of NT-proBNP in the setting of hypertension has not been well-characterized in the general US adult population.

METHODS

We measured NT-proBNP in stored blood samples collected from participants 1 year or older who participated in the 1999–2004 National Health and Nutrition Examination Survey. In adults 20 years or older without a history of cardiovascular disease, we assessed the prevalence of elevated NT-pro-BNP by blood pressure (BP) treatment and control categories. We examined the extent to which NT-proBNP identifies participants at higher risk for mortality across BP treatment and control categories.

RESULTS

Among US adults without CVD, the prevalence of elevated NT-proBNP (≥125 pg/ml) was 27.2% among those with untreated hypertension, 24.9% among those with treated controlled hypertension, and 43.3% among those with treated uncontrolled hypertension. Over a median follow-up of 17.3 years and after adjusting for demographic and clinical risk factors, US adults with treated controlled hypertension and elevated NT-proBNP had increased risk of all-cause mortality (HR 2.29, 95% CI 1.79, 2.95) and cardiovascular mortality (HR 3.83, 95% CI 2.34, 6.29), compared to adults without hypertension and with low levels of NT-proBNP (<125 pg/ml). Across all levels of SBP and irrespective of antihypertensive medication use, elevated NT-proBNP was associated with an increased risk of mortality, compared to low levels of NT-proBNP.

CONCLUSIONS

Among a general population of adults free of CVD, NT-proBNP can provide additional prognostic information within and across categories of BP. Measurement of NT-proBNP may have potential for clinical use to optimize hypertension treatment.
Yeast β-glucan modulates macrophages and improves antitumor NK-cell responses in cancer
Authors: Zhu Zhichao , He Liuyang , Bai Yu , Xia Lei , Sun Xiao , Qi Chunjian
Published: July 2023

As the largest proportion of myeloid immune cells in tumors, macrophages play an important role in tumor growth and regression according to their different phenotypes, thus reprogramming macrophages has become a new research direction for cancer immunotherapy. Yeast-derived whole β-glucan particles (WGPs) can induce M0 macrophages to differentiate into M1 macrophages and convert M2 macrophages and tumor-associated macrophages (TAMs) into M1 macrophages. In vitro, studies have confirmed that WGP-treated macrophages increase the activating receptors in natural killer cells (NK cells) and enhance the cytotoxicity of NK cells. The extracellular regulated protein kinases (ERK) signaling pathway is involved in WGP-mediated regulation of the macrophage phenotype. Further in vivo studies show that oral WGP can significantly delay tumor growth, which is related to the increased proportion of macrophages and NK cells, the macrophage phenotype reversal, and the enhancement of NK cell immune function. NK-cell depletion reduces the therapeutic efficacy of WGP in tumor-bearing mice. These findings revealed that in addition to T cells, NK cells also participate in the antitumor process of WGP. It was confirmed that WGP regulates the macrophage phenotype to regulate NK-cell function.
Protozoan predation as a driver of diversity and virulence in bacterial biofilms
Authors: Hoque M Mozammel , Espinoza-Vergara Gustavo , McDougald Diane
Published: July 2023

Protozoa are eukaryotic organisms that play a crucial role in nutrient cycling and maintaining balance in the food web. Predation, symbiosis and parasitism are three types of interactions between protozoa and bacteria. However, not all bacterial species are equally susceptible to protozoan predation as many are capable of defending against predation in numerous ways and may even establish either a symbiotic or parasitic life-style. Biofilm formation is one such mechanism by which bacteria can survive predation. Structural and chemical components of biofilms enhance resistance to predation compared to their planktonic counterparts. Predation on biofilms gives rise to phenotypic and genetic heterogeneity in prey that leads to trade-offs in virulence in other eukaryotes. Recent advances, using molecular and genomics techniques, allow us to generate new information about the interactions of protozoa and biofilms of prey bacteria. This review presents the current state of the field on impacts of protozoan predation on biofilms. We provide an overview of newly gathered insights into (i) molecular mechanisms of predation resistance in biofilms, (ii) phenotypic and genetic diversification of prey bacteria, and (iii) evolution of virulence as a consequence of protozoan predation on biofilms.
New insights into the tectonics and geodynamics of Botswana from intracrustal structures revealed by receiver function analysis
Authors: Mpuang Admore Phindani , Shibutani Takuo , Ntibinyane Onkgopotse
Published: July 2023

Recent improvements in seismic coverage allow for an increasingly detailed knowledge of the crustal structure beneath Botswana to be obtained. For the first time, shear wave velocity–depth models throughout Botswana are obtained from genetic algorithm inversion of receiver functions. In this approach, averaging of important structural variations is minimized by separating receiver function waveforms into backazimuth and slowness bins. Division of crustal layers into sediment, upper, middle and lower crust reveals important features that enhance our knowledge of tectonics and geodynamics of Botswana. In the west, beneath the Ghanzi-Chobe belt, as well as at the border region of the Zimbabwe craton with Magondi belt, the crust has been thickened through a thickening of the lower crust, most likely by collisional tectonics during the Damara Orogeny. A significant difference in structure is observed between the western and central-to-eastern Kaapvaal craton. Western Kaapvaal craton has a thin mafic lower crust (<10 km) that has survived the extensive melting of the Ventersdorp tectonomagmatic event at 2.7 Ga, contrary to previous reports of a lack of a mafic lower crust. Meanwhile in central-to-eastern Kaapvaal craton, a lower average ${{{}{V}}}_{{}{s}}$ (∼3.3 km s−1) in the upper crust suggests the presence of a suture zone that separates the two blocks of the Kaapvaal craton of different ages and crustal thicknesses. A relatively low ${{{}{V}}}_{{}{s}}$ in the middle crust from the Okavango rift zone to central and SE Botswana suggests reactivation of Palaeoproterozoic shear zones along a thin and weak crust by intraplate relative motion has enabled fluid infiltration from the mantle which causes seismicity in the region. Furthermore, a NW–SE trending region of high Vs in crustal layers is likely related to Karoo flood magmatism that formed the NW–SE trending Okavango dyke swarm. There is also an indication that a dedicated study is required to further investigate shallow converted phases from mobile belts and sedimentary basins in Botswana, however, the results from this study can provide a good starting point for such a study.
Restricting Representations from a Complex Reductive Group to a Real Form
Authors: Mason-Brown Lucas
Published: July 2023

Let $ G $ be a complex connected reductive algebraic group and let $ G_{{\mathbb {R}}} $ be a real form of $ G $. We construct a sequence of functors $ L_{n}\mathcal {R}$ from admissible (resp. finite-length) representations of $ G $ to admissible (resp. finite-length) representations of $ G_{{\mathbb {R}}} $. We establish many basic properties of these functors, including their behavior with respect to infinitesimal character, associated variety, and restriction to a maximal compact subgroup. We deduce that each $ L_{n}\mathcal {R}$ takes unipotent representations of $ G $ to unipotent representations of $ G_{{\mathbb {R}}} $. Taking the alternating sum of $ L_{n}\mathcal {R}$, we get a well-defined homomorphism on the level of characters. We compute this homomorphism in the case when $ G_{{\mathbb {R}}} $ is split.
CPlantBox: a fully coupled modelling platform for the water and carbon fluxes in the soil–plant–atmosphere continuum
Authors: Giraud Mona , Gall Samuel Le , Harings Moritz , Javaux Mathieu , Leitner Daniel , Meunier Félicien , Rothfuss Youri , van Dusschoten Dagmar , Vanderborght Jan , Vereecken Harry , Lobet Guillaume , Schnepf Andrea
Published: July 2023

A plant’s development is strongly linked to the water and carbon flows in the soil–plant–atmosphere continuum. Expected climate shifts will alter the water and carbon cycles and will affect plant phenotypes. Comprehensive models that simulate mechanistically and dynamically the feedback loops between a plant’s three-dimensional development and the water and carbon flows are useful tools to evaluate the sustainability of genotype–environment–management combinations which do not yet exist. In this study, we present the latest version of the open-source three-dimensional Functional–Structural Plant Model CPlantBox with PiafMunch and DuMu${}^{\text{x}}$ coupling. This new implementation can be used to study the interactions between known or hypothetical processes at the plant scale. We simulated semi-mechanistically the development of generic C3 monocots from 10 to 25 days after sowing and undergoing an atmospheric dry spell of 1 week (no precipitation). We compared the results for dry spells starting on different days (Day 11 or 18) against a wetter and colder baseline scenario. Compared with the baseline, the dry spells led to a lower instantaneous water-use efficiency. Moreover, the temperature-induced increased enzymatic activity led to a higher maintenance respiration which diminished the amount of sucrose available for growth. Both of these effects were stronger for the later dry spell compared with the early dry spell. We could thus use CPlantBox to simulate diverging emerging processes (like carbon partitioning) defining the plants’ phenotypic plasticity response to their environment. The model remains to be validated against independent observations of the soil–plant–atmosphere continuum.
Implementation of a Rapid Multiplex Polymerase Chain Reaction Pneumonia Panel and Subsequent Antibiotic De-escalation
Authors: Miller Molly M , Van Schooneveld Trevor C , Stohs Erica J , Marcelin Jasmine R , Alexander Bryan T , Watkins Andrew B , Creager Hannah M , Bergman Scott J
Published: July 2023

Background

Net effects of implementation of a multiplex polymerase chain reaction (PCR) pneumonia panel (PNP) on antimicrobial stewardship are thus far unknown. This retrospective study evaluated the real-world impact of the PNP on time to antibiotic de-escalation in critically ill patients treated for pneumonia at an academic medical center.

Methods

This retrospective, quasi-experimental study included adult intensive care unit (ICU) patients with respiratory culture results from 1 May to 15 August 2019 (pre-PNP group) and adult ICU patients with PNP results from 1 May to 15 August 2020 (PNP group) at Nebraska Medical Center. Patients were excluded for the following reasons: any preceding positive coronavirus disease 2019 PCR test, lack of antibiotic receipt, or non–respiratory tract infection indications for antibiotics. The primary outcome was time to discontinuation of anti–methicillin-resistant Staphylococcus aureus (MRSA) therapy. Secondary outcomes included time to discontinuation of antipseudomonal therapy, frequency of early discontinuation for atypical coverage, and overall duration (in days) of antibiotic therapy for pneumonia.

Results

Sixty-six patients in the pre-PNP group and 58 in the PNP group were included. There were significant differences in patient characteristics between groups. The median time to anti-MRSA agent discontinuation was 49.1 hours in the pre-PNP and 41.8 hours in the PNP group (P = .28). The median time to discontinuation of antipseudomonal agents was 134.4 hours in the pre-PNP versus 98.1 hours in the PNP group (P = .47). Other outcomes were numerically but not significantly improved in our sample.

Conclusions

This early look at implementation of a multiplex PNP did not demonstrate a statistically significant difference in antibiotic use but lays the groundwork to further evaluate a significant real-world impact on antibiotic de-escalation in ICU patients treated for pneumonia.
A Woman in Berlin: Reappraising Mass Sexual and Gender-Based Violence in Public Health
Authors: Bansal Esha
Published: July 2023

Preventing sexual and gender-based violence—and mitigating its devastating impacts on individuals and societies—is a central challenge of public health. A Woman in Berlin is 34-year-old journalist Marta Hillers’s first-hand account of life during the 1945 Red Army occupation of Berlin at the conclusion of World War II, when Russian soldiers collectively raped 2 million German civilians. Reflecting upon Hillers’s testimony, I argue that historical narratives about large-scale acts of sexual and gender-based violence deserve a more central place in public health discourse. I also question how the ethical challenges of memorializing and studying mass crimes might inform future public health efforts to advance gender equity and mitigate sexual violence globally.
The Impact of Nordic Pole Walk Advice Alone or in Combination With Exercise Strategies on Daily Physical Activity in Patients With Intermittent Claudication: A Randomized Clinical Trial
Authors: Sandberg Anna , Nordanstig Joakim , Cider Åsa , Jivegård Lennart , Hagströmer Maria , Bäck Maria
Published: July 2023

Objective

The impact of exercise interventions on physical activity (PA) remains undetermined in intermittent claudication, which is why it is important to include objectively measured PA as an additional endpoint. The aim of this prespecified secondary analysis of a randomized clinical trial was to investigate the impact of unsupervised Nordic pole walk advice (WA) alone or in combination with hospital-based supervised exercise (SEP) or home-based structured exercise (HSEP) on PA in patients with intermittent claudication.

Methods

In total, 166 patients with intermittent claudication (mean age = 72 [SD = 7.4] y; 41% women) were randomized to 3 intermittent claudication-treatment strategies: WA, WA + SEP, or WA + HSEP. All patients received Nordic poles and standardized WA (≥30 min, 3 times weekly). Patients randomized to HSEP and SEP accepted participation in an additional 6-months exercise program. PA was measured with an accelerometer-based activPAL3 monitor for 7 days at baseline and at 3, 6, and 12 months. PA outcomes were steps per day, time spent within a stepping cadence ≥100 steps per minute, time spent upright, number of body transitions from sitting to standing, and number of sitting bouts of >30 minutes and >60 minutes.

Results

At 1 year, no intergroup differences were observed in any of the PA variables, whereas significant intergroup differences were observed at 3 months regarding time spent within a stepping time cadence ≥100 steps per minute. The mean change for HSEP (2.47 [SD = 10.85] min) was significantly different from the mean change for WA (−3.20 [SD = 6.24] min). At 6 months, the number of sitting bouts (>60 min) for SEP was significantly different from WA (mean change = 0.24 [SD = 0.69] vs −0.23 [SD = 0.81]).

Conclusion

This study indicates that the addition of 6 months of HSEP or SEP does not improve PA at 1 year, as compared to unsupervised WA alone. Factors of importance for increasing PA in patients with intermittent claudication require further investigation.

Impact

At the 1-year follow-up, the addition of intermittent claudication-tailored additional exercise strategies did not improve daily PA in patients with intermittent claudication compared with unsupervised Nordic pole WA alone. Future studies may explore the role of behavior change techniques to increase PA in this patient group.
Solving Serial Acquirer Puzzles
Authors: Macias Antonio J , Rau P Raghavendra , Stouraitis Aris
Published: July 2023

Using a novel typology of serial acquirers, we examine several puzzles documented in the prior literature. We show that acquisitions by different types of acquirers are driven by different factors, they acquire different sizes of targets, and subsequent acquisitions by acquirers are predictable ex ante. Controlling for market anticipation, the most frequent serial acquirers do not earn declining returns as they continue acquiring, while less frequent acquirers do. Our methodology enhances our understanding of serial acquisition dynamics, anticipation, and economic value adjustments. The methodology is likely to be relevant to topics related to event anticipation beyond those covered in this study. (JEL G14, G34, G35)
Scalable Bayesian Divergence Time Estimation With Ratio Transformations
Authors: Ji Xiang , Fisher Alexander A , Su Shuo , Thorne Jeffrey L , Potter Barney , Lemey Philippe , Baele Guy , Suchard Marc A
Published: July 2023

Divergence time estimation is crucial to provide temporal signals for dating biologically important events from species divergence to viral transmissions in space and time. With the advent of high-throughput sequencing, recent Bayesian phylogenetic studies have analyzed hundreds to thousands of sequences. Such large-scale analyses challenge divergence time reconstruction by requiring inference on highly correlated internal node heights that often become computationally infeasible. To overcome this limitation, we explore a ratio transformation that maps the original $N-1$ internal node heights into a space of one height parameter and $N-2$ ratio parameters. To make the analyses scalable, we develop a collection of linear-time algorithms to compute the gradient and Jacobian-associated terms of the log-likelihood with respect to these ratios. We then apply Hamiltonian Monte Carlo sampling with the ratio transform in a Bayesian framework to learn the divergence times in 4 pathogenic viruses (West Nile virus, rabies virus, Lassa virus, and Ebola virus) and the coralline red algae. Our method both resolves a mixing issue in the West Nile virus example and improves inference efficiency by at least 5-fold for the Lassa and rabies virus examples as well as for the algae example. Our method now also makes it computationally feasible to incorporate mixed-effects molecular clock models for the Ebola virus example, confirms the findings from the original study, and reveals clearer multimodal distributions of the divergence times of some clades of interest.
Care for the patient with hip pain
Authors: Kearns Gary A. , Moore Amy Karen , Munger Larry , Seth Shelly , Day Mercedes
Published: July 2023

Hip pain is a common and sometimes disabling condition that affects adults in the primary care setting. The NP must understand the assessment, diagnosis, and treatment options for patients with hip pain. Proper care of these patients often involves conservative medical management and coordination with physical therapy.
Association of State Insurance Mandates for Fertility Treatment With Multiple Embryo Transfer After Preimplantation Genetic Testing for Aneuploidy
Authors: Bedrick Bronwyn S. , Nickel Katelin B. , Riley Joan K. , Jain Tarun , Jungheim Emily S.
Published: July 2023

(Abstracted from JAMA Network Open 2023;6(1):e2251739)

Multiple gestation is one of the most common risks associated with fertility treatment, such as in vitro fertilization (IVF). Compared with singleton pregnancies, pregnancies with multiples are at increased risk of maternal and neonatal morbidity and mortality as well as higher health care costs.
Outcomes of Menstrual Management Use in Transgender and Gender-Diverse Adolescents
Authors: Schwartz Beth I. , Bear Benjamin , Short Vanessa L. , Kazak Anne E.
Published: July 2023

(Abstracted from Obstet Gynecol 2023;141:748–755)

For those who do not identify as female, gender dysphoria may be exacerbated by the onset of menses and they may desire menstrual management. Also known as menstrual manipulation or suppression, menstrual management entails hormonal medication use for stopping or improving periods.
A Double-blinded, Randomized Trial Comparing Surgeon-Administered Transversus Abdominis Plane Block With Placebo After Midline Laparotomy in Gynecologic Oncology Surgery
Authors: Bernard Laurence , Lavecchia Melissa , Trepanier Gabrielle , Mah Sarah , Pokoradi Alida , McGinnis Justin M. , Alyafi Mohammad , Glezerson Bryan , Nguyen Julie , Carlson Vanessa , Helpman Limor , Elit Laurie , Jimenez Waldo , Eiriksson Lua , Reade Clare J.
Published: July 2023

(Abstracted from Am J Obstet Gynecol 2023;228:553.e1–553.e8)

The transversus abdominis plane (TAP) block is an anesthetic technique wherein a local anesthetic solution is into the fascial plane between the transversus abdominis and the internal oblique muscles. The TAP block has been shown to reduce requirements of opioids after surgery; however, it can be time-consuming for use in the operating room setting.
Pembrolizumab Plus Chemotherapy in Advanced Endometrial Cancer
Authors: Eskander Ramez N. , Sill Michael W. , Beffa Lindsey , Moore Richard G. , Hope Joanie M. , Musa Fernanda B. , Mannel Robert , Shahin Mark S. , Cantuaria Guilherme H. , Girda Eugenia , Mathews Cara , Kavecansky Juraj , Leath Charles A. , Gien Lilian T. , Hinchcliff Emily M. , Lele Shashikant B. , Landrum Lisa M. , Backes Floor , O'Cearbhaill Roisin E. , Al Baghdadi Tareq , Hill Emily K. , Thaker Premal H. , John Veena S. , Welch Stephen , Fader Amanda N. , Powell Matthew A. , Aghajanian Carol
Published: July 2023

(Abstracted from N Engl J Med 2023;388(23):2159–2170)

Endometrial cancer is one of the only cancer types for which both incidence and mortality are rising, and survival has not improved during the past 4 decades. First-line treatment for advanced or recurrent endometrial cancer typically involves paclitaxel plus carboplatin.
Tibial Plateau Fractures Complicated by Compartment Syndrome are Associated with a Three Times Higher Cost of Care
Authors: Kantor Adam H. , Clapp Ian , O’Neill Dillon C. , Daryoush Joshua R. , Myhre Luke A. , Marchand Lucas , Haller Justin M.
Published: July 2023

OBJECTIVES:

To determine the impact of acute compartment syndrome (ACS) and identify cost-drivers of 1-year total treatment costs for operative tibial plateau fractures.

DESIGN:

Retrospective review.

SETTING:

Level 1 Trauma Center.

PATIENTS:

337 patients with tibial plateau fractures, 24 of which were complicated by ACS.

OUTCOMES:

The primary outcome was total treatment cost over the first year for operatively treated tibial plateau fractures. The secondary objective was to use regression analysis to identify significant cost drivers.

RESULTS:

The diagnosis of ACS was associated with 2.85 times higher in total treatment cost (p < 0.001). Acute compartment syndrome demonstrated increased total treatment cost when controlling for polytrauma (p < 0.001) and post-operative infection (p < 0.001). Regression analysis identified 5 variables significantly associated with total cost of care: Body Mass Index, Injury Severity Score, ACS, Staged External Fixation, and Locking Fixation (p < 0.001; R2 = 0.57). The diagnosis of ACS had the largest impact on total cost with a 3.5x greater impact on cost compared to the next highest variable, staged external-fixation.

CONCLUSIONS:

Tibial plateau fractures complicated by ACS are associated with 2.85 times higher treatment costs over a 1-year period. There were 5 significant variables identified by regression analysis with ACS having the highest impact on total treatment. Together, these 5 factors account for 57% of treatment cost variability.

LEVEL OF EVIDENCE:

Economic Level III. See Instructions for Authors for a complete description of levels of evidence.
Interprofessional Team Conflict Resolution: A Critical Literature Review
Authors: Orchard Carole , King Gillian , Tryphonopoulos Panagiota , Gorman Eunice , Ugirase Sibylle , Lising Dean , Fung Kevin
Published: July 2023

Introduction:

Although concern related to conflicts within health care teams has been discussed in the literature, most studies have focused on individuals' personal conflict management style identification or on managers resolving workplace conflicts between parties. The purpose of this review was to identify significant components in the field of conflict with particular attention to conceptual findings that may be integrated into understanding interprofessional health care team conflict and its resolution.

Methods:

A critical review of the conflict literature across many fields was undertaken using the method identified by Grant and Booth, incorporating literature—search, appraisal, synthesis, and analysis.

Results:

This critical review explored existing models and schools of thought to provide an overview of how conflict is conceptualized, its focus on interpersonal and workplace issues, team conflict application and training in team conflict resolution, and finally a summary of this review's contribution to interprofessional health care team conflict and its resolution.

Conclusions:

Team conflict is comprised of three forms—relationship, task, and process. When team building occurs that incorporates training in the use of an adapted constructive controversy approach, there is a greater opportunity to enhance the quality of a cooperative approach to patients' care planning. Training in team conflict resolution is needed as a key ingredient to ensure all team members can enhance the effectiveness and quality of interprofessional client-centered collaborative practice. This benefits not only the health providers in the team, but also their clients/patients who are recipients of their shared teamwork.
The Overwhelming Postsplenectomy Sepsis: Role of Plastic Surgeon
Authors: Starnoni Marta , Pappalardo Marco , Marra Caterina , Pinelli Massimo , De Santis Giorgio
Published: July 2023

The overwhelming post-splenectomy infection (OPSI) is a feared late complication of splenectomy, with high morbidity and a mortality rate of up to 50%. Although the management of this syndrome is the duty of clinical physicians, the interest of plastic surgeons in OPSI is related to the injury that can occur in tissues with an end circulation, such as the limb extremities, nasal tip, and lips. In the management of OPSI, surgical techniques are not highlighted. The role of the plastic surgeon can be fundamental for the prevention of further extension of the necrotic tissue, improving as much as possible the vascularization around it. Moreover, a critical role in the management of OPSI is avoiding superinfection of the necrotic areas by combining different techniques and methods, such as surgical debridements, negative pressure wound therapy, and conservative treatment. Last but not least, functional and aesthetic restoration of the injured parts is of paramount importance for the final outcome. In this article, we describe the management of two unvaccinated patients with necrosis of the extremities after OPSI.
Distal Bypass to the Deep Palmar Arch for Treatment of a Unique Presentation of Digital Ischemia
Authors: Lee Nayun , Gehring Michael B. , Washington Kia M.
Published: July 2023

Radial artery occlusion leading to hand ischemia is a serious problem that may require prompt surgical intervention. Due to the rarity of these events, consensus on the most effective surgical approach has not yet been reached. There is even scarce literature on appropriate management of symptomatic radial occlusion in patients with a congenital variation in hand vasculature. We report on a case of a 38-year-old woman with radial artery occlusion who underwent a successful distal radial artery bypass to the deep palmar arch due to a diminutive ulnar artery and the absence of a superficial palmar arch. Radial artery bypass to the deep palmar arch using a reversed vein graft is a viable treatment option for preventing further digital ischemia or necrosis in patients with a compromised vasculature of the hand.
Beyond Physical Well-being: Exploring Demographic Variances in Psychosocial Well-being before Breast Reconstruction
Authors: Kebede Sara N. , Martin Morgan S. , Baker Nusaiba F. , Saad Omar A. , Losken Albert
Published: July 2023

Background:

A patient’s preoperative satisfaction with their breasts and baseline psychosocial, sexual, and physical well-being are important considerations when planning breast reconstruction. We sought to elucidate variances in preoperative responses among patients undergoing postmastectomy breast reconstruction.

Methods:

Preoperative BREAST-Q responses and demographic data, including race, generation, median household incomeinstitutional review board and body mass index (BMI) were collected from breast cancer patients scheduled for mastectomy. Associations between demographic group and survey response were analyzed by chi-square or independent t-tests.

Results:

In total, 646 of 826 patients identified had complete data and were included in the final analysis. Patients in BMI group 1 (16–24.9) were more likely to report feeling “very satisfied” with how they looked unclothed compared with patients in other BMI groups (P = 0.031). Conversely, patients in groups 3 and 4 (35+), reported lower satisfaction (P = 0.037) and felt less attractive without clothes (P = 0.034). Asian women were less likely to feel attractive (P = 0.007), and Black patients were less likely to feel of equal worth to other women (P < 0.001). Finally, patients were less likely to report confidence in social settings if they were Black (P < 0.001), Asian (P < 0.001), from the millennial generation (P = 0.017), or living in zip codes with median household income less than $55,000 (P = 0.042).

Conclusions:

Breast cancer patients’ feelings toward their natural breasts vary widely between demographic groups. Understanding baseline psychosocial factors in this population is key to informing preoperative discussions and interpreting postoperative satisfaction.
Practice Trends in the Management of Asymptomatic Breast Reconstruction Patients with Textured Implants: A Survey Analysis
Authors: Roider Laura A. , Nguyen David C. , Pusapadi Ramkumar Shreya , Tyson Cody V. , Lund Herluf G. , Plikaitis Christina M.
Published: July 2023

Background:

Despite the increasing prevalence of breast implant associated anaplastic large cell lymphoma, there remains a paucity of literature guiding management of asymptomatic patients with textured breast implants. This risk can be anxiety provoking in breast reconstruction patients given their history of cancer or increased future risk. The purpose of this study is to evaluate current practice trends when managing the concerned asymptomatic patient following textured implant-based breast reconstruction.

Methods:

An electronic survey was distributed to members of the American Society of Plastic Surgeons, regarding management of asymptomatic breast reconstruction patients with textured devices. Anonymous responses were collected, and statistical analysis was performed.

Results:

A total of 304 responses were received. Of respondents, 237 (92%) have managed asymptomatic patients with textured devices. Historically, the overwhelming majority (89%) used textured devices; however, only 25% report current use. Regarding management of asymptomatic breast reconstruction patients, 87% recommend conservative management, while 13% recommend surgical management. When surgery is performed, 16.3% of respondents elected for implant exchange, 33.8% recommended implant exchange with partial capsulectomy, and 49.8% elected for implant exchange with total capsulectomy. Evaluation of practice patterns based on demographics demonstrated statistically significant differences in current use of textured devices and management of acellular dermal matrix.

Conclusions:

Despite decreased current use, there is a significant population of asymptomatic breast reconstruction patients with a history of textured devices concerned for risk of breast implant associated anaplastic large cell lymphoma. This survey demonstrates ongoing variability in surgeon recommendations regarding conservative and surgical management of these patients and the need for continued development of evidence-based guidelines.
Rapid monophasic HBsAg decline during nucleic-acid polymer–based therapy predicts functional cure
Authors: Hershkovich Leeor , Shekhtman Louis , Bazinet Michel , Pântea Victor , Placinta Gheorge , Cotler Scott J. , Vaillant Andrew , Dahari Harel
Published: July 2023

Background and Aims:

Analyzing the interplay among serum HBV DNA, HBsAg, anti-HBs, and alanine aminotransferase (ALT) during nucleic-acid polymer (NAP)-based therapy for chronic hepatitis B provides a unique opportunity to identify kinetic patterns associated with functional cure.

Methods:

All participants with HBeAg-negative chronic HBV infection in the REP 401 study (NCT02565719) first received 24 weeks of tenofovir-disoproxil-fumarate (TDF) monotherapy. The early triple therapy group (n = 20) next received 48 weeks of TDF+pegylated interferon-α2a (pegIFN)+NAPs. In contrast, the delayed triple therapy group (n = 20) next received 24 weeks of TDF+pegIFN before 48 weeks of triple therapy. Three participants discontinued treatment and were excluded. Functional cure (HBsAg and HBV DNA not detectable with normal ALT) was assessed at 48 weeks post-treatment. Different kinetic phases were defined by at least a 2-fold change in slope. A single-phase decline was categorized as monophasic, and 2-phase declines were categorized as biphasic.

Results:

Fourteen (35%) participants achieved a functional cure. HBV DNA remained below or near undetectable for all participants by the end of TDF monotherapy and during subsequent combination therapies. Three HBsAg kinetic patterns were found in both the early and delayed groups, nonresponders (n = 4 and n = 4), monophasic (n = 11 and n = 11), and biphasic (n = 4 and n = 3), respectively. All participants who achieved a functional cure had a monophasic HBsAg kinetic pattern during triple therapy. Among participants with a monophasic HBsAg decline, those who had a functional cure had a shorter median time to HBsAg loss of 21 (interquartile range=11) weeks compared with those who did not achieve functional cure [median: 27 (7) weeks] (p = 0.012).

Conclusions:

Functional cure was associated with a rapid monophasic HBsAg decline during NAP-based therapy. A nonmonophasic HBsAg kinetic pattern had a 100% negative predictive value (NPV) for a functional cure.
Optical Genome Mapping Identifies Novel Recurrent Structural Alterations in Childhood ETV6::RUNX1+ and High Hyperdiploid Acute Lymphoblastic Leukemia
Authors: Brandes Danielle , Yasin Layal , Nebral Karin , Ebler Jana , Schinnerl Dagmar , Picard Daniel , Bergmann Anke K. , Alam Jubayer , Köhrer Stefan , Haas Oskar A. , Attarbaschi Andishe , Marschall Tobias , Stanulla Martin , Borkhardt Arndt , Brozou Triantafyllia , Fischer Ute , Wagener Rabea
Published: July 2023

The mutational landscape of B-cell precursor acute lymphoblastic leukemia (BCP-ALL), the most common pediatric cancer, is not fully described partially because commonly applied short-read next generation sequencing has a limited ability to identify structural variations. By combining comprehensive analysis of structural variants (SVs), single-nucleotide variants (SNVs), and small insertions-deletions, new subtype-defining and therapeutic targets may be detected. We analyzed the landscape of somatic alterations in 60 pediatric patients diagnosed with the most common BCP-ALL subtypes, ETV6::RUNX1+ and classical hyperdiploid (HD), using conventional cytogenetics, single nucleotide polymorphism (SNP) array, whole exome sequencing (WES), and the novel optical genome mapping (OGM) technique. Ninety-five percent of SVs detected by cytogenetics and SNP-array were verified by OGM. OGM detected an additional 677 SVs not identified using the conventional methods, including (subclonal) IKZF1 deletions. Based on OGM, ETV6::RUNX1+ BCP-ALL harbored 2.7 times more SVs than HD BCP-ALL, mainly focal deletions. Besides SVs in known leukemia development genes (ETV6, PAX5, BTG1, CDKN2A), we identified 19 novel recurrently altered regions (in n ≥ 3) including 9p21.3 (FOCAD/HACD4), 8p11.21 (IKBKB), 1p34.3 (ZMYM1), 4q24 (MANBA), 8p23.1 (MSRA), and 10p14 (SFMBT2), as well as ETV6::RUNX1+ subtype-specific SVs (12p13.1 (GPRC5A), 12q24.21 (MED13L), 18q11.2 (MIB1), 20q11.22 (NCOA6)). We detected 3 novel fusion genes (SFMBT2::DGKD, PDS5B::STAG2, and TDRD5::LPCAT2), for which the sequence and expression were validated by long-read and whole transcriptome sequencing, respectively. OGM and WES identified double hits of SVs and SNVs (ETV6, BTG1, STAG2, MANBA, TBL1XR1, NSD2) in the same patient demonstrating the power of the combined approach to define the landscape of genomic alterations in BCP-ALL.
Baseline Characteristics of 1976 Patients With Ectatic Corneal Disorders at a Single Center From 2010 to 2021: A Cross-Sectional Study of the Homburg Keratoconus Center
Authors: Sideroudi Haris , Flockerzi Elias , Daas Loay , Jullien Theresia , Xanthopoulou Kassandra , Hamon Loïc , Seitz Berthold
Published: July 2023

Objectives:

The study objective was to analyze the baseline characteristics of keratoconus (KC) patients at the Homburg Keratoconus Center from 2010 to 2021.

Methods:

This cross-sectional study included 3,674 eyes, with analysis of demographics, clinical findings, visual function, endothelial measurements, and topographic, tomographic, and corneal biomechanical data from the first visit.

Results:

Mean patient age was 36.3±13.8 years. The mean uncorrected distance visual acuity in log of minimal angle of resolution was 0.60 (20/80, Snellen equivalent), and the corrected mean was 0.3 (20/40). Of 1976 patients, 48.9% reported eye rubbing. Mean values (ranges) were 49.4±6.3 (36.3–78.0) D for steep keratometry, 462.4±66.0 (48.0–659.0) μm for thinnest corneal thickness, 9.7±8.7 (−0.5 to 88.8) for Belin/Ambrósio enhanced ectasia total deviation, 0.8±0.4 (0.0–1.0) for the Corvis biomechanical index, 0.9±0.2 (0.0–1.0) for the tomographic biomechanical index, 0.1±0.5 (−0.9 to 2.0) for the KC match index, 8.3±1.8 (2.2–17.7) mm Hg for corneal hysteresis, 7.1±2.2 (0.0–17.0) mm Hg for corneal resistance factor, and 2,562.9±326.3 (1,011–3,937) cells/mm2 for endothelial cell density. The average ABCDE KC stage was A2B3C1D1E2. Distance-corrected visual acuity correlated strongly with topometric, tomographic, and biomechanical data (P<0.001).

Conclusions:

This comprehensive description of baseline features of KC patients at a tertiary center provides a reference for further longitudinal and international multicentric studies.
High Tidal Volume, High Positive End Expiratory Pressure and Apneic Breath Hold Strategies (Lung Navigation Ventilation Protocol) With Cone Beam Computed Tomography Bronchoscopic Biopsy of Peripheral Lung Lesions
Authors: Bhadra Krish , Baleeiro Carlos , Patel Sumit , Condra William , Bader Brittany Amento , Setser Randolph M. , Youngblood Sloan
Published: July 2023

Background:

A dedicated anesthesia protocol for bronchoscopic lung biopsy—lung navigation ventilation protocol (LNVP)—specifically designed to mitigate atelectasis and reduce unnecessary respiratory motion, has been recently described. LNVP demonstrated significantly reduced dependent ground glass, sublobar/lobar atelectasis, and atelectasis obscuring target lesions compared with conventional ventilation.

Methods:

In this retrospective, single-center study, we examine the impact of LNVP on 100 consecutive patients during peripheral lung lesion biopsy. We report the incidence of atelectasis using cone beam computed tomography imaging, observed ventilatory findings, anesthesia medications, and outcomes, including diagnostic yield, radiation exposure, and complications.

Results:

Atelectasis was observed in a minority of subjects: ground glass opacity atelectasis was seen in 30 patients by reader 1 (28%) and in 18 patients by reader 2 (17%), with good agreement between readers (κ = 0.78). Sublobar/lobar atelectasis was observed in 23 patients by reader 1 and 26 patients by reader 2, also demonstrating good agreement (κ = 0.67). Atelectasis obscured target lesions in very few cases: 0 patients (0%, reader 1) and 3 patients (3%, reader 2). Diagnostic yield was 85.9% based on the AQuIRE definition. Pathology demonstrated 57 of 106 lesions (54%) were malignant, 34 lesions (32%) were benign, and 15 lesions (14%) were nondiagnostic.

Conclusion:

Cone beam computed tomography images confirmed low rates of atelectasis, high tool-in-lesion confirmation rate, and high diagnostic yield. LNVP has a similar safety profile to conventional bronchoscopy. Most patients will require intravenous fluid and vasopressor support. Further study of LNVP and other ventilation protocols are necessary to understand the impact of ventilation protocols on bronchoscopic peripheral lung biopsy.
Best Practices for Promoting Safe Patient Care Delivery by Hospital-Based Traveling Clinical Staff
Authors: Krzyzewski Julia , Cook Michelle , Memken Amanda , Johnson Micayla , Francis Sarah E. , Romao Bailey , White Jessica , Bowers Jade , Watson Heather , Whalen Madeleine
Published: July 2023

Background:

Hospitals use traveling clinical staff (TCS) to fill personnel shortages. Although this approach may help improve staffing ratios, it is not without risk.

Purpose:

The interdisciplinary team conducted an integrative literature review to determine best practices for promoting safe patient care delivery by TCS.

Methods:

Using the Johns Hopkins Evidence-Based Practice model, the authors performed an integrative literature review, including appraisal of quality, synthesis of themes, and best-evidence recommendations.

Results:

The final synthesis included 16 articles. Evidence demonstrated the importance of preemployment screening, standardized onboarding and orientation, and optimizing the integration of TCS into the work environment.

Conclusion:

Hospitals should use these recommendations when incorporating TCS into their teams.
Internet-Based Treatment of Body Dysmorphic Disorder
Authors: Schoenenberg Katrin , Bosbach Katharina , Baumeister Harald , Küchler Ann-Marie , Hartmann Andrea Sabrina , Harrer Mathias , Ebert David Daniel , Martin Alexandra
Published: July 2023

Initial findings indicate the effectiveness of internet-based interventions for body dysmorphic disorder (BDD). In order to substantiate these findings, a seven-module guided internet-based intervention was created and examined. We report the mixed data of participants with clinical and subclinical BDD of the treatment group (n = 18). We investigated the feasibility, the quality of the program content, the design and usability, and its effects on symptom severity and related psychopathology. Adherence to the intervention was low and dropout rate high (55.6%). The program content, perceived website usability, and visual aesthetic were rated high. Credibility and expectancy were on a medium level. Satisfaction with appearance improved significantly in the intention-to-treat analysis (d = 0.58). In sum, symptom-related outcomes and program evaluation showed a positive trend albeit the study conduction was difficult. Future programs should investigate the role of additional motivation strategies and more flexible support addressing the known treatment barriers.
The Course Patterns and Diagnostic Shifts of Patients With Schizoaffective Disorder
Authors: Yıldırım Yusuf Ezel , Çetinay Aydın Pınar , Gümüşay Uğur Merve
Published: July 2023

Since its introduction, schizoaffective disorder (SAD) has been one of the most controversial diagnoses in psychiatry, both clinically and nosologically. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), SAD diagnostic criteria were changed, and instead of a cross-sectional diagnosis, a longitudinal approach covering the life course of the illness was adopted. In this study, the meaning of this conceptual shift in the diagnosis of SAD in clinical practice is investigated throughout the course of the illness for patients with SAD. Sixty-two inpatients diagnosed with SAD according to DSM-5 diagnostic criteria are included in this study. The course of the illness from its onset to the present is investigated retrospectively. The disease duration is 18.3 ± 9.1 years. The most common diagnoses in the first hospitalization are bipolar disorder (manic episodes) and psychotic disorder, not otherwise specified. Furthermore, the time that elapsed between the first psychiatric application of the patients and the diagnosis of SAD is 9.5 ± 7.3 years. Further, when the course of the illness is grouped according to the predominance of affective and psychotic disorders, recurrent affective disorders are observed most frequently (29.3%), followed by mixed-episode disorders and a shift from affective disorders to psychotic disorders (22.4%). It is found that SAD has a heterogeneous course, and affective disorder diagnoses are more dominant during the course of the illness. The clinical relevance of the longitudinal emphasis on the total duration of the illness in the DSM-5 is also demonstrated. The affective and psychotic dichotomy, based on Kraepelin, has failed to elucidate the course of the disease in clinical practice. Therefore, clinicians should meticulously evaluate the entire course of the illness for SAD and avoid conclusive judgments over a single episode.
Cannabis and Pregnancy: A Review
Authors: Hayer Sarena , Mandelbaum Ava D. , Watch Lester , Ryan Kimberly S. , Hedges Madeline A. , Manuzak Jennifer A. , Easley Charles A. , Schust Danny J. , Lo Jamie O.
Published: July 2023

Importance

Prenatal cannabis use is rising and is a major public health issue. Cannabis use in pregnancy and during lactation has been associated with increased maternal and offspring morbidity and mortality.

Objective

This review aims to summarize the existing literature and current recommendations for cannabis use during pregnancy or lactation.

Evidence Acquisition

A PubMed, Cochrane Library, and Google Scholar literature search using the following terms was performed to gather relevant data: “cannabis,” “cannabinoid,” “delta-9-tetrahydrocannabinol,” “THC,” “cannabidiol,” “fetal outcomes,” “perinatal outcomes,” “pregnancy,” and “lactation.”

Results

Available studies on cannabis use in pregnancy and during lactation were reviewed and support an association with increased risk of preterm birth, neonatal intensive care unit admission, low birth weight, and small-for-gestational-age infants.

Conclusion and Relevance

There is a critical need for research on the effects of cannabis use in pregnancy and during lactation. This is a necessary first step before furthering patient education, developing interventions, and targeting antenatal surveillance to ameliorate the adverse impacts on maternal and fetal health.

Target Audience

Obstetricians and gynecologists, family physicians, pediatricians

Learning Objectives

After participating in this activity, the learner should be better able to describe options for treatment of cannabis use disorder; explain common forms of cannabinoids available for use; and discuss screening options for cannabis use in pregnancy.