bluuebunny/crossref_metadata_2025 huggingface dataset:
Numerical implementation of the Cubic Galileon model in pinocchio
Authors: Song Yanling , Moretti Chiara , Monaco Pierluigi , Hu Bin
Published: August 2022

We present a perturbative treatment of non-linear galaxy clustering in the context of the cubic Galileon modified gravity model, in terms of second-order Lagrangian Perturbation theory and an extension of ellipsoidal collapse that includes Vainshtein screening. We numerically implement such prescriptions in the approximate pinocchio code, and use it to generate realizations of the matter density field and halo catalogues with different prescriptions for ellipsoidal collapse. We investigate the impact of three different approximations in the computation of collapse times on the halo mass function, halo bias, and matter power spectrum. In the halo mass function, both the modified gravity effect and the screening effect are significant in the high-mass end, similar to what is found for other MG models. We perform a comparison with N-body simulations to assess the validity of our approach, and show that we can reproduce the same trend observed in simulations for all quantities considered. With a simple modification to the grouping algorithm of pinocchio to take into account the gravity modification, and without the need to re-calibrate the algorithm, we show that we can reproduce the linear halo bias and the mildly non-linear matter power spectrum of simulations with good accuracy, especially for the implementation with Vainshtein screening. We stress that, while approximate, our method is orders of magnitude faster than a full N-body simulation, making it an optimal tool for the quick generation of large sets of halo catalogues for cosmological observables.
Analysis of spin directions of galaxies in the DESI Legacy Survey
Authors: Shamir Lior
Published: August 2022

The DESI Legacy Survey is a digital sky survey with a large footprint compared to other Earth-based surveys, covering both the Northern and Southern hemispheres. This paper shows the distribution of the spin directions of spiral galaxies imaged by DESI Legacy Survey. A

simple analysis of dividing nearly 1.3 × 106 spiral galaxies into two hemispheres shows a higher number of galaxies spinning counterclockwise in the Northern hemisphere, and a higher number of galaxies spinning clockwise in the Southern hemisphere. That distribution is consistent with previous observations, but uses a far larger number of galaxies and a larger footprint. The larger footprint allows a comprehensive analysis without the need to fit the distribution into an a priori model, making this study different from all previous analyses of this kind. Fitting the spin directions of the galaxies to cosine dependence shows a dipole axis alignment with probability of P < 10−5. The analysis is done with a trivial selection of the galaxies, as well as simple explainable annotation algorithm that does not make use of any form of machine learning, deep learning, or pattern recognition. While further work will be required, these results are aligned with previous studies suggesting the possibility of a large-scale alignment of galaxy angular momentum.
Nanocatalytic bacteria disintegration reverses immunosuppression of colorectal cancer
Authors: Jiang Han , Guo Yuedong , Yu Zhiguo , Hu Ping , Shi Jianlin
Published: August 2022

Tumor-associated bacteria (TAB) play a critically important role in regulating the microenvironment of a tumor, which consequently greatly deteriorates the therapeutic effects by chemo- and radiotherapy deactivation and, more considerably, leads to substantial immunosuppression. On the contrary, herein we propose a nanocatalytic tumor-immunotherapeutic modality based on the bacteria disintegration by bacteria-specific oxidative damage under magnetic hyperthermia for highly effective immune response activation-promoted tumor regression. A monodispersed and superparamagnetic nanocatalytic medicine modified by arginyl-glycyl-aspartic acid (RGD) and (3-carboxypropyl)triphenylphosphonium bromide (TPP), named as MNP-RGD-TPP herein, has been synthesized, which features selective accumulation at the TAB by the electrostatic affinity, enabling effective TAB disintegration by the nanocatalytic Fenton reaction producing abundant cytotoxic hydroxyl radicals in situ under alternating magnetic field-induced hyperthermia. More importantly, the lipopolysaccharide has been metabolically secreted from the destructed TAB as pathogen-associated molecular patterns (PAMPs) to M1-polarize tumor-associated macrophages (TAMs) and promote the maturation of dendritic cells (DCs) for innate immuno-response activation of TAMs, followed by cytotoxic T lymphocytes awakening under the PAMPs presentation by the mature DCs against tumor cells. The integrated innate and adaptive immunity activations based on this TAB-promoted nanocatalytic immunomedicine, instead of magnetic heating-induced hyperthermia or the released Fe2+/Fe3+ Fenton agent, has been found to achieve excellent therapeutic efficacy in an orthotopic colorectal cancer model, demonstrating the great potential of such an integrated immunity strategy in clinical tumor immunotherapy.
Identification and semisynthesis of (−)-anisomelic acid as oral agent against SARS-CoV-2 in mice
Authors: Yu Hai-Xin , Zheng Nan , Yeh Chi-Tai , Lee Chien-Ming , Zhang Qi , Zheng Wen-Lv , Chang Qing , Li Yuan-He , Li Yu-Jun , Wu Gui-Zhen , Quan Jun-Min , Zhang Lin-Qi , Tzeng Yew-Min , Yang Zhen
Published: August 2022

(−)-Anisomelic acid, isolated from Anisomeles indica (L.) Kuntze (Labiatae) leaves, is a macrocyclic cembranolide with a trans-fused α-methylene-γ-lactone motif. Anisomelic acid effectively inhibits SARS-CoV-2 replication and viral-induced cytopathic effects with an EC50 of 1.1 and 4.3 μM, respectively. Challenge studies of SARS-CoV-2-infected K18-hACE2 mice showed that oral administration of anisomelic acid and subcutaneous dosing of remdesivir can both reduce the viral titers in the lung tissue at the same level. To facilitate drug discovery, we used a semisynthetic approach to shorten the project timelines. The enantioselective semisynthesis of anisomelic acid from the naturally enriched and commercially available starting material (+)-costunolide was achieved in five steps with a 27% overall yield. The developed chemistry provides opportunities for developing anisomelic-acid-based novel ligands for selectively targeting proteins involved in viral infections.
Establishing the Association Between Snus Use and Mental Health Problems: A Study of Norwegian College and University Students
Authors: Tjora Tore , Skogen Jens Christoffer , Sivertsen Børge
Published: August 2022

Introduction

Smoking and mental health problems are public health concerns worldwide. Studies on smoke-free tobacco products, especially snus are scarce. Snus is considered less harmful than smoking and in the United States allowed to be marketed accordingly, but may still add to the burden of disease.

Aims and Methods

Data stem from the Norwegian Students’ Health and Wellbeing Study (SHoT study) in 2018 (162 512 invited, 50 054 (30.8%) completed). Smoking, snus use, health service and medication usage and mental health problems, including the Hopkins Symptom Checklist-25 (HSCL-25), were assessed using self-report. The aims were to explore the associations between smoking and snus use and mental health problems and treatments. Furthermore, the association between both daily smoking and daily snus use and mental health problems. Associations were tested with χ2-, t-tests, and logistic regression.

Results

Daily snus users had 38% increased odds (odds ratio [OR]: 1.38, CI: 1.30 to 1.46), and daily smokers had 96% increased odds (OR: 1.96, CI: 1.65 to 2.34) of having a high HSCL-25 score, adjusted for gender, low socioeconomic status (SES), using tobacco, participating in therapy and using antidepressants daily.

Conclusions

Both daily smoking and daily snus use were associated with an increased level of mental health problems. The adjusted probability for mental health problems was lower for snus use; however, snus use prevalence was tenfold in our sample.

Implications

Despite the lack of causal and directional conclusions, these associations may have implications for future legislation on snus. They also highlight the importance of more research, especially as snus is considered less harmful and seemingly replacing smoking in Norway.
Hepatitis B–Related Hepatic Flare During Immune Reconstitution Syndrome After Antiretroviral Treatment Initiation in an HBV Surface Antigen–Positive Patient With HIV: Viroimmunological and Histological Characterization
Authors: Iannetta Marco , Crea Angela M A , Di Lorenzo Andrea , Campogiani Laura , Teti Elisabetta , Malagnino Vincenzo , Compagno Mirko , Coppola Luigi , Piermatteo Lorenzo , Palmieri Giampiero , Cimino Carolina , Salpini Romina , Zingaropoli Maria A , Ciardi Maria R , Mastroianni Claudio M , Parisi Saverio G , Svicher Valentina , Andreoni Massimo , Sarmati Loredana
Published: August 2022

HIV and hepatitis B virus (HBV) coinfection is relatively common. Initiation of antiretroviral therapy (ART) in people with HIV (PWH) causes a progressive restoration of cell-mediated immune functions. In the presence of overt or occult coinfections, immune restoration might lead to immune reconstitution inflammatory syndrome (IRIS). Here, we describe the clinical, immunological, virological, and histological characterization of a case of HBV-related IRIS hepatitis in a PWH after ART initiation. A liver biopsy was performed during HBV-related IRIS hepatic flare, and liver samples were analyzed through immunohistochemistry and molecular techniques, with the assessment of intrahepatic HBV-DNA, covalently closed circular DNA, and HBV pregenomic RNA through a droplet digital polymerase chain reaction system. Immune activation and senescence were also longitudinally assessed. In this clinical case, the hepatic flare occurred 6 weeks after ART initiation with a therapeutic regimen including tenofovir alafenamide (TAF) and emtricitabine (FTC). The episode was self-limiting, characterized by hyperactivation of peripheral blood CD4+ and CD8+ T-lymphocytes, and resolved without ART discontinuation, leading to the achievement of HBsAg seroconversion (HBsAg-/HBsAb+) and HBV-DNA plasma undetectability. Notably, hyperactivation of the immune system plays a pivotal role in promoting the control of HBV replication, thus triggering the achievement of HBsAg seroconversion during treatment with TAF/FTC.
Regarding “Management of Dermatologic Events Associated with the Nectin-4–directed Antibody-Drug Conjugate Enfortumab Vedotin”
Authors: Ingen-Housz-Oro Saskia , Thibault Constance , Sohier Pierre , Dupin Nicolas
Published: August 2022

This letter to the editor remarks on a recently published article about dermatologic events induced by enfortumab vedotin, comparing results from other similar studies.
Plankton digital twins—a new research tool
Authors: Flynn Kevin J , Torres Ricardo , Irigoien Xabier , Blackford Jerry C
Published: August 2022

Digital twins (DT) are simulation models that so closely replicate reality in their behaviour that experts may believe model output to be real. Plankton offer worthy yet tractable biological targets for digital twinning, due to their relatively simply physiology and significant role in ecology from theoretical studies through to planetary scale biogeochemistry. Construction of dynamic plankton DT (PDT), representing a supreme test of our understanding of plankton ecophysiology, would form the basis of education and training aids, provide platforms for hypothesis setting/testing, experiment design and interpretation, and support the construction and testing of large-scale ecosystem models and allied management tools. PDTs may be constructed using concepts from systems biology, with system dynamics, including feedback controls akin to biological (de)repression processes, to provide a robust approach to model plankton, with flexible core features enabling ready and meaningful configuration of phenotypic traits. Expert witness validation through Turing Tests would provide confidence in the end product. Through deployment of PDTs with appropriate input controls and output (visualization) tools, empiricists are more likely to engage with modelling, enhancing future science and increasing confidence in predictive operational and also in long-term climate simulations.
Kinetic mixing, custodial symmetry, and a lower bound on the mass of a dark gauge boson
Authors: Napsuciale M , Rodríguez S , Hernández-Arellano H
Published: August 2022

We consider the extension of the standard model by dark fields with an Abelian spontaneously broken gauge symmetry in a hidden dark matter scenario. The dimension-four gauge-invariant terms include a kinetic mixing term and a Higgs mixing term, and we show that, after spontaneous symmetry breaking, the tree-level relation $M^{2}_{W}=M^{2}_{\tilde{Z}} \cos ^{2} \tilde{\theta }_{w}$ holds and permits us to write the mixing angle induced by the kinetic mixing in the neutral massive gauge boson sector, θζ, in terms of the values of MZ, the weak mixing angle, and of the mass of the physical dark gauge boson ZD. At the loop level, a similar relation is obtained in the $\overline{MS}$ scheme. Using the result extracted from the global fit to electroweak precision data for the ratio $\rho _{0}=M^{2}_{W}/\hat{c}^{2}_{Z} M^{2}_{Z}\hat{\rho }$, we obtain the lower bound $M_{Z_{D}}\gt M_{Z}$ for the dark gauge boson mass at the $94\%$ confidence level. We argue that this lower bound holds in the general case of theories for physics beyond the standard model with an extra U(1) gauge factor subgroup, whenever the extended Higgs potential respects custodial symmetry.
Potential protective effect of escin from Aesculus hippocastanum extract against cyclophosphamide-induced oxidative stress on rat tissues
Authors: Küçükkurt İsmail , Akbel Erten , İnce Sinan , Acaröz Damla Arslan , Demirel Hasan Hüseyin , Kan Fahriye
Published: August 2022

Cyclophosphamide (CP)—also known as cytophosphan—is an alkylating agent that has many side effects in humans and rats. Rats were divided into 5 different groups to evaluate the protective effect of escin (ES) obtained from the horse-chestnut plant (Aesculus hippocastanum) against acute damage induce by CP. Groups: control group, ethanol group, ES group (100 mg/kg body weight (bw) ES for 14 days by gastric gavage), ES + CP group (100 mg/kg bw ES for 14 days by gastric gavage and 75 mg/kg bw CP i.p. on 14th day), and CP group (75 mg/kg bw CP i.p. on 14th day). After the experiment was completed, blood and tissue samples (liver, kidney, heart, brain, lung, and testis) were taken from the rats under anesthesia. When the CP group was compared with the control group, an increase was observed in the level of Malondialdehyde (MDA) in blood and all tissues except the lung, but when it was given together with escin, there was a decrease except kidney and lung (P < 0.05). Glutathione (GSH) level decreased in the blood and all tissues when CP was given, whereas an increase was observed in the heart, brain, and lung when given with escin (P < 0.05). There was no statistical change in the activities of superoxide dismutase and catalase enzymes in all tissues. ES reduced CP-induced damage in all tissues except the kidney. As a result, it was determined that ES had a protective effect against CP-induced tissue damage in rats due to its antioxidant properties.
COVID-19 Pandemic: Effects of Replacing Clinical Hours With Virtual Simulation in BSN Prelicensure Nursing Education
Authors: Roberts Sterling , Warren Talecia , Moore Leslie C.
Published: August 2022

At the onset of the COVID-19 pandemic, many academic institutions suspended in-person instruction and clinical experiences. Virtual simulation played an essential role in providing alternatives. The current study used faculty and student surveys, along with standardized exit exams and NCLEX-RN® pass rates, to determine the effect of using virtual simulation instead of traditional hospital clinical experiences during the final semester of a prelicensure BSN program. Results indicated a small decrease in exit exam scores compared to those who completed the traditional clinical experience and no significant relationship between NCLEX-RN pass/fail rates.
Utilizing Telehealth Modalities for Veteran Nursing Students’ Primary Health Care Clinical Experiences During the COVID-19 Pandemic
Authors: Patel Sarah E. , Chalaron Kathleen , Liesveld Judy
Published: August 2022

Clinical experiences are critical for undergraduate nursing students to apply didactic learning experiences and meet the core competencies established for licensure. However, the coronavirus (COVID-19) pandemic severely limited access to clinical experiences for undergraduate nursing students. The VA Home Telehealth program provided unique clinical experiences for veteran undergraduate nursing students, increased the use of technology, and limited the adverse effects of the pandemic in a rural, vulnerable population. This collaboration was crucial in helping students progress with their nursing education during a time of crisis.
A Concept Analysis of Structural Competency
Authors: Melino Katerina , Olson Joanne , Hilario Carla
Published: August 2022

Structural competency is a concept that offers a way to understand and respond to health inequities and work toward antiracism in health care. This article undertakes a concept analysis of structural competency using Rodgers' evolutionary method. Based on this analysis, structural competency refers to the ability to recognize and act on structural inequities, skill development, multidisciplinary collaboration, and the reproduction of inequity over time. The meanings and use of this concept differ among disciplines. Multidisciplinary applications of structural competency offer insight into how this concept can foster health equity and antiracism in nursing care, education, research, and health services delivery.
Best Practice Guidelines for Surgical Site Infection in High-risk Pediatric Spine Surgery: Definition, Prevention, Diagnosis, and Treatment
Authors: Badin Daniel , Leland Christopher R. , Matsumoto Hiroko , Roye Benjamin , Vitale Michael , Flynn John , Samdani Amer , Larson A. Noelle , Yaszay Burt , Pahys Joshua , Glotzbecker Michael , Bachmann Keith R. , Newton Peter O. , Betz Randal , Miyanji Firoz , Shah Suken , Sturm Peter F. , Hwang Steven , Erickson Mark , Cahill Patrick J. , Fletcher Nicholas , Upasani Vidyadhar V. , Sucato Daniel J. , Sponseller Paul D.
Published: August 2022

Background:

Prior “best practice guidelines” (BPG) have identified strategies to reduce the risk of acute deep surgical site infection (SSI), but there still exists large variability in practice. Further, there is still no consensus on which patients are “high risk” for SSI and how SSI should be diagnosed or treated in pediatric spine surgery. We sought to develop an updated, consensus-based BPG informed by available literature and expert opinion on defining high-SSI risk in pediatric spine surgery and on prevention, diagnosis, and treatment of SSI in this high-risk population.

Materials and Methods:

After a systematic review of the literature, an expert panel of 21 pediatric spine surgeons was selected from the Harms Study Group based on extensive experience in the field of pediatric spine surgery. Using the Delphi process and iterative survey rounds, the expert panel was surveyed for current practices, presented with the systematic review, given the opportunity to voice opinions through a live discussion session and asked to vote regarding preferences privately. Two survey rounds were conducted electronically, after which a live conference was held to present and discuss results. A final electronic survey was then conducted for final voting. Agreement ≥70% was considered consensus. Items near consensus were revised if feasible to achieve consensus in subsequent surveys.

Results:

Consensus was reached for 17 items for defining high-SSI risk, 17 items for preventing, 6 for diagnosing, and 9 for treating SSI in this high-risk population. After final voting, all 21 experts agreed to the publication and implementation of these items in their practice.

Conclusions:

We present a set of updated consensus-based BPGs for defining high-risk and preventing, diagnosing, and treating SSI in high-risk pediatric spine surgery. We believe that this BPG can limit variability in practice and decrease the incidence of SSI in pediatric spine surgery.

Level of Evidence:

Not applicable.
Presence of Antibodies to Severe Acute Respiratory Syndrome Coronavirus-2 on Admission Is Associated With Decreased Mortality in COVID-19 Critical Illness
Authors: Mabrey F. Linzee , Zelnick Leila R. , Morrell Eric D. , O’Connor Nicholas G. , Hart Andrew , Wurfel Mark M. , Liles W. Conrad , Bhatraju Pavan K.
Published: August 2022

OBJECTIVES:

To determine whether the early serologic response in COVID-19 critical illness is associated with hospital mortality. To evaluate if time-to-seroconversion differs by receipt of dexamethasone therapy.

DESIGN:

Patients were prospectively enrolled within 24 hours of ICU admission from two University of Washington Hospitals. Plasma was collected on enrollment and on days 3, 7, 10, and 14.

SETTING:

ICUs between March 2020 and April 2021.

PATIENTS:

Consecutive adults with COVID-19 admitted to an ICU.

MEASUREMENTS AND MAIN RESULTS:

We measured longitudinal total antispike protein antibody levels (anti-S abs) and total antinucleocapsid antibody levels (anti-N ab) using a U.S. Food and Drug Administration-authorized Roche instrument. We evaluated whether detectable anti-S abs on ICU admission were associated with host factors, initial disease severity, and hospital mortality. We evaluated whether dexamethasone therapy was associated with time-to-seroconversion. Among 93 unvaccinated participants, 47 (51%) had detectable anti-S abs on ICU admission. There was no difference in Acute Physiology and Chronic Health Evaluation II score or time between first positive severe acute respiratory syndrome coronavirus-2 PCR and ICU admission in those with detectable versus undetectable anti-S abs. Adjusting for age, body mass index, and sex, patients with detectable anti-S abs had a lower risk of inhospital death (hazard ratio, 0.40; 95% CI, 0.17–0.94; p = 0.04). Among 21 patients with undetectable anti-S abs on ICU admission and serial measurements available, time-to-seroconversion was not significantly affected by receipt of dexamethasone therapy.

CONCLUSIONS:

In COVID-19 critical illness, a significant proportion of patients do not have detectable antibodies at ICU admission, and this is independent of severity of illness. Detectable anti-S abs were associated with lower risk of inhospital death. Despite concern that corticosteroids may impair an appropriate antiviral serologic response, early antibody kinetics were not significantly affected by administration of dexamethasone; however, CIs were wide and require further study.
An Extended PD-L2 Cytoplasmic Domain Results From Alternative Splicing in NSCLC Cells
Authors: Dietz Lisa Loksø , Furman Natasja Toft , Larsen Trine Vilsbøll , Daugaard Tina Fuglsang , Thomsen Emil Aagaard , Keller Johanne Lade , Aagaard Lars , Sorensen Boe Sandahl , Nielsen Anders Lade
Published: August 2022

Antibody–based immunotherapy targeting the interaction between programmed cell death 1 (PD-1) and its ligand PD-L1 has shown impressive clinical outcomes in various cancer types, including nonsmall cell lung cancer (NSCLC). However, regulatory mechanisms in this immune checkpoint pathway still needs clarification. PD-L2 is structurally homologous to PD-L1 and is a second PD-1 ligand. Alternative mRNA splicing from the CD274 and PDCD1LG2 genes holds the potential to generate PD-L1 and PD-L2 isoforms, respectively, with novel functionality in regulation of the PD-1 immune checkpoint pathway. Here, we describe alternative splicing in NSCLC cells potentially generating eight different PD-L2 isoforms from the PDCD1LG2 gene. Extension of exon 6 by four nucleotides is the most prominent alternative splicing event and results in PD-L2 isoform V with a cytoplasmic domain containing a 10 amino acid extension. On average 13% of the PDCD1LG2 transcripts in NSCLC cell lines and 22% of the transcripts in NSCLC tumor biopsies encode PD-L2 isoform V. PD-L2 isoform V localizes to the cell surface membrane but less efficiently than the canonical PD-L2 isoform I. The cytoplasmic domains of PD-1 ligands can affect immune checkpoint pathways by conferring membrane localization and protein stability and thereby represent alternative targets for immunotherapy. In addition, cytoplasmic domains are involved in intracellular signalling cascades in cancer cells. The presented observations of different cytoplasmic domains of PD-L2 will be important in the future delineation of the PD-1 immune checkpoint pathway.
Antimicrobial susceptibility of bacteria isolated from urine cultures in Southern Turkey
Authors: Baran Caner , Küçükcan Akif
Published: August 2022

Background

Pathogen spectrum and antibiotic susceptibility patterns vary in different regions and should consider the empirical treatment of urinary tract infections (UTIs). Information on susceptibility is the basis for providing reliable treatment. This study aimed to determine the antibiotic susceptibility of bacteria isolated from urine cultures at Çukurova State Hospital, which is located south of Turkey and east of the Mediterranean region.

Materials and methods

Urine culture results were retrospectively evaluated between April 2018 and January 2021. Variables, such as age, sex, and medical department, were also recorded. Inclusion criteria were patients aged at least 18 years with pathogenic bacterial growth in their urine cultures. Antibiotic susceptibility testing and bacterial identification were performed using the VITEK 2 automated system.

Results

Of 12,288 urine samples, 2033 (16.5%) had pathogenic growth. The rates of bacterial and yeast growth were 93.3% and 6.7%, respectively. Gram-negative pathogens constituted 91.6% of the cohort. The most prevalent bacteria were Escherichia coli with a 66% rate, followed by Klebsiella (14.2%). According to our results, ciprofloxacin, trimethoprim-sulfamethoxazole, and ampicillin are not suitable for empirical treatment of UTIs, whereas nitrofurantoin and fosfomycin are rational options.

Conclusions

Uropathogens exhibit an increased resistance rate against ampicillin, trimethoprim-sulfamethoxazole, and ciprofloxacin. Nitrofurantoin, fosfomycin, and ceftazidime have better efficacy than other investigated antibiotics in urine culture against common uropathogens and are suitable for empirical treatment of UTI.
The treatment of endometriosis-associated infertility
Authors: Spencer Stuart , Lazaridis Alexandros , Grammatis Alexandros , Hirsch Martin
Published: August 2022

Purpose of review

To review the recent evidence around the treatment of infertility in patients with endometriosis.

Recent findings

The management of endometriosis associated infertility remains challenging. There have been an increasing number of prospective observational studies highlighting the role of surgery to enhance assisted conception amongst those with deep rectovaginal endometriosis. Further validation studies confirm the role of the endometriosis fertility index in prediction of reproductive outcomes after surgery, and confirm that it can be employed in counselling patients prior to surgery on their likelihood of spontaneous conception. Further randomized trials are required to establish the role of surgically treating superficial and deep endometriosis and both spontaneous and assisted conception outcomes.

Endometriosis continues to present challenges in counselling patients with regards to their fertility prospects. This article reviews the recent research findings that may assist in the management of patients with endometriosis associated infertility.
Progestins of today and tomorrow
Authors: Liu Serena , Kciuk Olga , Frank Madelyn , Tyson Nichole
Published: August 2022

Purpose of review

To review the current literature on the multiple types and uses of progestins in reproductive healthcare.

Recent findings

Progestins for contraceptive use are available in multiple forms, with the ongoing development of transdermal, intravaginal, and male contraception formulations. Noncontraceptive use of progestins often overlaps with contraceptive indications, which allows for simultaneous multipurpose progestin use, especially in reproductive-aged patients. More studies are needed to determine contraceptive doses of progestins used for noncontraceptive purposes. Side effect profiles of progestins are dependent on their formulation and cross-reactivity with other steroid receptors. Development of newer progestins includes manipulating pharmacologic properties to avoid undesired side effects.

Progestins have multiple uses in reproductive healthcare, including contraception, menstrual suppression, endometrial protection, and hormonal replacement therapy. The development of progestins for these indications can expand therapy for people with contraindications to estrogen-based hormonal therapy.
Platelet rich plasma for the management of urogynecological disorders: the current evidence
Authors: Prodromidou Anastasia , Grigoriadis Themos , Athanasiou Stavros
Published: August 2022

Purpose of review

Our objective is to review the currently available literature on the use of platelet-rich plasma (PRP) in patients with pelvic floor disorders and to critically appraise the latest evidence on the safety and efficacy of the PRP application.

Recent findings

The evidence on the use of PRP for the treatment of stress urinary incontinence (SUI) appears promising, although limited to case series, case reports and animal studies. PRP has also been proposed to enhance the surgical outcomes of pelvic organ prolapse (POP) by native tissue repair with promising success rates. The application of PRP in other PFDs including vaginal fistulas, genitourinary syndrome of menopause (GSM), mesh exposure and lichen sclerosus has been also associated with beneficial outcomes and a favorable safety profile.

The currently available literature indicates that PRP could have a beneficial effect as a single or adjuvant treatment in patients with SUI, POP, GSM, vaginal fistula and genital lichen sclerosus with minimal adverse events. However, valid evidence is still lacking and further well-designed studies are warranted in the field to confirm the validity of the so far reported outcomes.
Branch retinal artery occlusion in a young patient after radiotherapy for nasopharyngeal carcinoma
Authors: Jiahui Elizabeth Chen , Helen Mi Fang
Published: August 2022

Purpose:

To report a case of branch retinal artery occlusion (BRAO) in a young patient who received previous neck radiotherapy for nasopharyngeal carcinoma.

Methods:

We describe an interesting case of a branch retinal artery occlusion in a patient with previous neck radiotherapy for nasopharyngeal carcinoma 14 years ago.

Patient:

The patient was a 49 year old male, who presented to the retina service in Tan Tock Seng Hospital.

Results:

Ultrasound of the carotid arteries revealed more than 50% bilateral common carotid arteries stenosis, and 80-99% bilateral internal carotid artery (ICA) stenosis. Magnetic resonance imaging of the brain showed presence of chronic infarcts. Screening for hypercoaguable states and cardioembolic causes were unremarkable.

Conclusion:

Head and neck irradiation is a significant risk factor for developing carotid stenosis and its consequent complications such as retinal artery occlusions and cerebrovascular events.
Patient-Reported Outcomes in Keratoconus: A Save Sight Keratoconus Registry Study
Authors: Kandel Himal , Pesudovs Konrad , Nguyen Vuong , Chen Jern Yee , Poon Alexander , Mills Richard , Watson Stephanie L.
Published: August 2022

Purpose:

The aim of this study was to evaluate the quality-of-life (QoL) status in keratoconus severity subgroups using the Keratoconus Outcomes Research Questionnaire (KORQ) and to determine the relationship between the QoL scores and the standard clinical variables.

Methods:

A cross-sectional study was conducted using prospective, web-based Save Sight Keratoconus Registry data. Rasch analysis was conducted on the KORQ data using the Andrich Rating Scale Model. Comparative analysis included Welch t test and 1-way ANOVA. Associations between visual acuity, corneal curvature, and minimum corneal thickness with KORQ scores were evaluated with Pearson correlation and multiple regression adjusted for age and sex.

Results:

The KORQ was completed by 542 patients with keratoconus (male, 67.7%; mean age, 31.6 years). Keratoconus severity, based on Kmax, was mild [<48 diopter (D)], moderate (48–55 D), and severe (>55 D) in 26.3%, 45.0%, and 28.7% of patients, respectively. Activity limitation (AL) and symptoms (SY) scales of the KORQ had robust psychometric properties including well-functioning response categories, unidimensionality, excellent measurement precision, and satisfactory fit statistics. In a group-wise analysis, the female patients had significantly lower AL and SY scores. Similarly, the severe keratoconus group had the worst AL and SY scores. Contact lens wearers had worse KORQ scores than the spectacles wearers. Overall, statistically significant but weak correlations between KORQ scores and visual acuity and corneal curvature (Kmax and K2) (Pearson r, 0.11–0.35) were observed. The correlations for SY were weaker than for AL scores.

Conclusions:

Female sex, contact lens wear, reduced visual acuity, and higher disease severity were associated with worse AL and SY scores in keratoconus. Although the correlations between clinical and QoL scores were statistically significant, the low magnitudes suggested a complex relationship between clinical parameters and patient-reported outcomes.
Spinal neurovascular coupling is preserved despite time-dependent alterations of spinal cord blood flow responses in a rat model of chronic back pain: implications for functional spinal cord imaging
Authors: Paquette Thierry , Eskandari Nasim , Leblond Hugues , Piché Mathieu
Published: August 2022

Functional magnetic resonance imaging has been used to investigate nociceptive processes in patients with chronic pain. However, the results may be confounded with changes in neurovascular coupling induced by chronic pain. The objective of this study was to examine spinal neurovascular coupling in a rat model of chronic back pain induced by muscle inflammation. Rats received 150 µL intramuscular injections of either complete Freund adjuvant (CFA: n = 18) or saline (control [CTL]: n = 18) in L5-L6 paravertebral muscles. Under 1.2% isoflurane anesthesia, spinal cord blood flow (SCBF) and local field potentials evoked by electrical stimulation of the sciatic nerve were recorded simultaneously in the lumbar enlargement of the spinal cord, 14 or 28 days after the injections. Mechanical hypersensitivity was observed in CFA rats compared with CTL rats for the back (P < 0.001) and hind paws (P < 0.01). Spinal cord blood flow response amplitude and local field potential amplitude were not significantly different between groups (day 14: P > 0.5; day 28: P > 0.6). However, the time course of SCBF responses was different between groups on day 14 (P < 0.001) and day 28 (P < 0.001). Nevertheless, neurovascular coupling was comparable between groups on days 14 and 28, whether neurovascular coupling was calculated with the amplitude or the area under the curve of SCBF responses (all P > 0.2). These results indicate that spinal hemodynamic changes reflect neuronal activity in this animal model, although the time course of SCBF responses is affected by chronic inflammatory back pain. This warrants a careful use of spinal functional magnetic resonance imaging in animal models and patients with chronic back pain.
Estimating individualized treatment effects using a risk-modeling approach: an application to epidural steroid injections for lumbar spinal stenosis
Authors: Liu Pinyan , Wu Yitao , Xiao Ziyu , Gold Laura S. , Heagerty Patrick J. , Annaswamy Thiru , Friedly Janna , Turner Judith A. , Jarvik Jeffrey G. , Suri Pradeep
Published: August 2022

Conventional “1-variable-at-a-time” analyses to identify treatment effect modifiers are often underpowered and prone to false-positive results. This study used a “risk-modeling” approach guided by the Predictive Approaches to Treatment effect Heterogeneity (PATH) Statement framework: (1) developing and validating a multivariable model to estimate predicted future back-related functional limitations as measured by the Roland–Morris Disability Questionnaire (RMDQ) and (2) stratifying patients from a randomized controlled trial (RCT) of lumbar epidural steroid injections (LESIs) for the treatment of lumbar spinal stenosis into subgroups with different individualized treatment effects on RMDQ scores at the 3-week follow-up. Model development and validation were conducted in a cohort (n = 3259) randomly split into training and testing sets in a 4:1 ratio. The model was developed in the testing set using linear regression with least absolute shrinkage and selection regularization and 5-fold cross-validation. The model was then applied in the testing set and subsequently in patients receiving the control treatment in the RCT of LESI. R

2
values in the training set, testing set, and RCT were 0.38, 0.32, and 0.34, respectively. There was statistically significant modification (P = 0.03) of the LESI treatment effect according to predicted risk quartile, with clinically relevant LESI treatment effect point estimates in the 2 quartiles with greatest predicted risk (−3.7 and −3.3 RMDQ points) and no effect in the lowest 2 quartiles. A multivariable risk-modeling approach identified subgroups of patients with lumbar spinal stenosis with a clinically relevant treatment effect of LESI on back-related functional limitations.
Key molecules of
Mucorales
for COVID-19-associated mucormycosis: a narrative review
Authors: Baberwal Priyanka , Singh Arjun , Adarsh Abhinav , Kumar Yatender
Published: August 2022

Mucormycosis is a lethal human disease caused by fungi of the order
Mucorales
. Mucormycosis is caused by fungi mainly belonging to the genera
Mucor, Rhizopus
, and
Lichtheimia
, all of which belong to the order
Mucorales
. The number of individuals with mucormycosis-causing disorders has increased in recent years, hence, leading to the spread of mucormycosis. Throughout the coronavirus disease 2019 (COVID-19) pandemic, numerous cases of mucormycosis in COVID-19-infected patients have been reported worldwide, and the illness is now recognized as COVID-19-associated mucormycosis, with most of the cases being reported from India. Immunocompromised patients such as those with bone marrow sickness and uncontrolled diabetes are at a greater risk of developing mucormycosis. Genes, pathways, and other mechanisms have been studied in
Mucorales
, demonstrating a direct link between virulence and prospective therapeutic and diagnostic targets. This review discusses several proteins such as high-affinity iron permease (FTR1), calcineurin, spore coat protein (CotH), and ADP-ribosylation factors involved in the pathogenesis of mucormycosis that might prove to be viable target(s) for the development of novel diagnostic and therapeutic methods.
Difficulties With Executive Function Are Associated With Risky Health Behaviors Among Young Adult Congenital Heart Defect Survivors
Authors: Fox Kristen R. , Vannatta Kathryn , Jackson Jamie L.
Published: August 2022

Background

Adults with congenital heart defects (CHDs) have an increased risk for cardiovascular complications, but few are in optimal cardiovascular health. Executive function deficits, which are elevated among CHD survivors, may contribute to engagement in behaviors that increase cardiovascular risk.

Objective

The aim of this study was to identify the association between executive function and the health risk behaviors of tobacco use, saturated fat intake, and insufficient physical activity among young adults with CHDs.

Methods

Young adults with CHDs completed the Behavior Rating Inventory of Executive Function–Adult Version, which yields composite and 9 individual domain scores (eg, inhibition, working memory). Participants also completed self-report measures of tobacco use, saturated fat intake, and physical activity. Linear and logistic regression models determined the association between executive function and risky health behaviors, adjusting for demographic factors, disease status, and emotional distress.

Results

One in 10 young adults with CHDs reported clinically significant difficulties with global executive function. Difficulties with global executive function were associated with increased tobacco use (P = .018) and greater saturated fat intake (P = .015) but not insufficient physical activity (P = .902). Difficulties with inhibition were specifically associated with increased tobacco use (P = .003) and greater saturated fat intake (P = .007), and problems with self-monitoring were associated with increased tobacco use (P = .017).

Conclusions

Executive function difficulties are associated with self-reported engagement in health risk behaviors among young adults with CHDs. Health behavior interventions for adult CHD survivors may require additional modifications that consider executive function problems, particularly difficulties with inhibition.
Do Hospitals Achieving “Leader in LGBTQ Healthcare Equality” Maintain Higher Patient Scores Compared To Nonleaders?
Authors: DiLeo Rita , Choi Seongwon , Hanneman Tari , Demirbas Ali Riza , Hearld K. Ria , Datti Paul , Borkowski Nancy
Published: August 2022

The lesbian, gay, bisexual, transgender, and queer (LGBTQ) population deals with complex medical and behavioral issues coupled with barriers in accessing both healthcare and health insurance leading to poorer health outcomes as compared with the general population. Because this community is often overlooked in efforts to improve minority health disparities, in 2007, the Human Rights Campaign Foundation introduced the Healthcare Equality Index (HEI) for evaluating healthcare facilities' policies and practices related to the equity and inclusion of their LGBTQ patients, visitors, and employees. This study's aim was to determine whether the LGBTQ Healthcare Equality Leader institution designation advantage found by DiLeo et al (2020) has a continuing positive effect on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) performance. We found that patient scores for both Overall Rating and Willingness to Recommend were higher with noted improvement for HEI Leader institutions as compared with non-HEI Leader institutions over this study's 3-year period. Based on the findings of this study, it can be implied that hospitals do receive a return on their investment for achieving or maintaining the HEI Leader designation and this investment benefits all populations served by the organization inferred by their maintained higher patient experience scores.
Interprofessional Collaborative Practice Improves Access to Care and Healthcare Quality to Advance Health Equity
Authors: White-Williams Connie , Bittner Vera , Eagleson Reid , Feltman Morgan , Shirey Maria
Published: August 2022

Healthcare disparites exist in cardiovascular care, including heart failure. Care that is not equitable can lead to higher incidence of heart failure, increased readmissions, and poorer outcomes. The Heart Failure Transitional Care Services for Adults Clinic is an interprofessional collaborative practice that provides guideline-directed medical therapy and education to underserved patients with heart failure. Little is known regarding healthcare equity and quality metrics in relation to interprofessional teams. Thus, the purpose of this study was to examine if an interprofessional collaborative practice care delivery model can affect access to care and healthcare quality outcomes in underserved patients with heart failure. As evidenced by control charts over a two and a half year period, the Heart Failure Transitional Care Services for Adults Clinic was able to show improvements in access to care and quality metrics results without variation. An interprofessional collaborative practice can be an effective delivery model to address health equity and quality of care outcomes.
Optimizing Unilateral Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Quality Improvement Study
Authors: Stern Carrie S. , Plotsker Ethan L. , Nelson Jonas A. , Matros Evan , Kalandranis Eleni , Fatterusso Dana , Mooney Colette , Chen Yigu , Velzen Jeena , Mehrara Babak J.
Published: August 2022

Deep inferior epigastric perforator (DIEP) flap surgery commonly involves multiday hospitalization, although data suggest 95% of complications after unilateral DIEP flap breast reconstruction occur within the first 24 hours. The aim of this study was to decrease hospitalization time and optimize care of patients undergoing unilateral DIEP flap breast reconstruction. Our study followed Six Sigma's DMAIC (define, measure, analyze, improve, control) framework. First, we delineated the stakeholders involved in the process and defined workgroups based on temporal relation to the operation. We measured performance according to project SMART (specific, measurable, achievable, relevant, time bound) goals and subsequently conducted an analysis of inefficiencies. We then created new interventions for quality improvement. Control will entail ongoing monitoring to ensure progress is sustained after study completion. Our interventions lasted 6 months and included 70 patients. By actively striving to advance patients through postoperative milestones during their inpatient stay and creating an outpatient nursing roadmap including aspects of inpatient care, we decreased the median length of stay from 67.8 to 44.8 hours (p < .001). After receiving nursing instruction, 77% of patients agreed that they felt ready to be discharged. Our study suggests that the DMAIC framework can decrease hospitalization time after DIEP surgery and spare resources for additional patients.
Impact of Faculty Training in Health Systems Science on Scholarly Presentation of Resident Physician and Fellow Quality Improvement Projects
Authors: Garris Jenna , Tumin Dmitry , Whitehurst Kelley , Riddick Alyson , Garrison Herbert G. , Reeder Timothy J. , Lawson Luan
Published: August 2022

The objective was to evaluate whether faculty participation in a Health Systems Science training program was associated with increased presentation and publication of quality improvement (QI) projects involving resident physicians and fellows at 1 institution. The authors evaluated annual, department-level counts of QI projects with resident physician or fellow involvement, presented locally or published, according to residency or fellowship program director and faculty participation in Teachers of Quality Academy. Ten clinical departments had 82 presentations and 2 publications. Each additional faculty member’s participation in Teachers of Quality Academy increased the annual count of published or presented QI projects by 9% (P < 0.001). At this institution, participation in a Health Systems Science training program among clinical faculty improved engagement of resident physicians and fellows in local presentation of QI projects.