bluuebunny/crossref_metadata_2025_split huggingface dataset:
P232 In the absence of idiopathic inflammatory myopathy, is the presence of anti-transcriptional intermediary factor-1 gamma clinically relevant for malignancy?
Authors: Cotton Caroline V , Keymer Catherine , McLaren Zoe 
Published: April 2022

Abstract

Background/Aims
The idiopathic inflammatory myopathies (IIMs) are associated with a number of antibodies which are linked to certain clinical phenotypes. The presence of anti-transcriptional intermediary factor-1 gamma (TIF-1y) is strongly associated with malignancy. However, it is uncertain whether the presence of this antibody, in the absence of IIM, should prompt further investigations to exclude an underlying malignancy.

Methods
Patients were identified who had undergone myositis immunoblot testing at Liverpool University Foundation Trust laboratories as part of their clinical care between January 2015 and January 2020. Adult patients were included if they tested TIF-1y antibody positive but had no evidence of IIM. Data was collected on patient demographics, whether this was a weak or strong antibody finding and whether there was the presence of other antibodies on the immunoblot panel. The clinical notes were then used to assess whether the patient was known to have a malignancy or went on to develop a malignancy during the follow up period.

Results
The presence of TIF-1y antibody occurred in 66 patients. Four patients were excluded from analysis, three due to a diagnosis of IIM and one due to a lack of clinical information. The average age was 69 years (range 35 - 88 years) and 59% were female. A strongly positive TIF-1y antibody was found in 19 patients, of which eight were associated with another positive antibody available on the immunoblot panel. There were five malignancies identified, two were historic diagnoses, one patient was found to have a lung malignancy at the time the panel was sent and two patients subsequently developed pancreatic malignancy. A weakly positive TIF-1y antibody was found in 43 patients, of which 16 results were associated with another positive antibody on immunoblot analysis, excluding three patients with a positive anti-Ro antibody. Of 11 patients with malignancy, five had a historic diagnosis and six patients developed malignancy over the follow up period.

Conclusion
The myositis immunoblot is a useful tool in patients with IIM. However, when used outside of this context can produce a number of positive results, the significance of which are unclear. In the case of TIF-1y and its known association with malignancy, this can lead to unnecessary investigations and increase patient anxiety. This data has obvious limitations as there may have been incomplete information if patients were managed elsewhere and the presence of TIF-1y did not lead to investigation for underlying malignancy in the majority of patients, meaning some cancers may have been present but remained undetected. The results do not suggest the presence of this antibody increases the likelihood of malignancy in patients without IIM but further studies are recommended.

Disclosure
C.V. Cotton: None. C. Keymer: None. Z. McLaren: None.
P242 Immunosuppressants can modify the transcriptomic signature in patients with systemic lupus erythematosus
Authors: Akthar Mumina , Nair Nisha ,   on behalf of the MASTERPLANS Consortium and BILAG BR Investigators, Bruce Ian N , Reynolds John A 
Published: April 2022

Abstract

Background/Aims
Transcriptomics has the potential to revolutionise the way we approach complex diseases such as systemic lupus erythematosus (SLE), which is both clinically and biologically heterogeneous. We aimed to explore whether deconvolution of whole blood transcriptomic data could predict differences in immune cell proportions between active SLE patients, and whether these are attributable to the SLE phenotype or medication use.

Methods
Patients with active SLE were recruited from the BILAG-Biologics Registry (BILAG-BR) prior to change in therapy. Disease activity was measured using the BILAG-2004 Index. Whole blood RNA-sequencing was conducted at baseline and FPKM-normalised data was deconvoluted using CIBERSORTx with the LM22 signature matrix used as reference. The effects of five different drugs (azathioprine, cyclophosphamide, hydroxychloroquine, methotrexate and mycophenolate mofetil [MMF]) were explored. Predicted cell frequencies were compared between active disease domains (defined by BILAG A or B score) and concomitant immunosuppressant use using Mann-Whitney U tests with Benjamini-Hochberg correction (significance at p &lt; 0.05).

Results
We recruited 109 patients of whom 104 (95.4%) were female, with a median (IQR) age of 38 years (29-49) years, disease duration of 10 (6.5, 16.5) years. Patients had active disease with a median SLEDAI score of 8 (4-14). For patients taking MMF (53/109, 46.8%), there was a lower proportion of macrophages M0 (0.435% vs 1.391%, p = 0.001), naïve CD4 T cells (0.961% vs 2.251%, p = 0.002) and regulatory T cells (1.858% vs 3.574%, p = 0.007), and a higher proportion of memory activated CD4 T cells (1.826% vs 1.113%, p = 0.015), when compared to patients not taking mycophenolate mofetil. MMF use was associated with statistically significant differences in predicted immune cell (macrophages m0, naïve CD4 T cells, regulatory T cells and memory activated CD4 T cells) frequency after adjusting for age, gender, ethnicity, disease duration, renal disease and steroid use. No differences were observed for the other immunosuppressants or between patients with active or inactive disease in each of the nine organ domains.

Conclusion
The use of immunosuppressants can significantly modify the transcriptomic signature in patients with SLE affecting key immune cell type populations differently, highlighting the need to adjust for background medication use in future studies, particularly in those using whole blood transcriptomics. It would also be valuable to evaluate the differences identified in this study to determine whether they can be used to monitor or predict treatment response.

Disclosure
M. Akthar: None. N. Nair: None. O. MASTERPLANS Consortium and BILAG BR Investigators: None. I.N. Bruce: None. J.A. Reynolds: None.
Safety of DIEP Flap Reconstruction in Patients with Factor V Leiden: A Retrospective Cohort Study
Authors: Veeramani Anamika , McCarty Justin C. , Vieira Brittany L. , Karinja Sarah , Pusic Andrea L. , Carty Matthew J. , Erdmann-Sager Jessica 
Published: April 2022

Background:
Factor V Leiden (FVL) is the most common inherited thrombophilia in White people. Thrombotic complications resulting from free flap breast reconstruction in FVL patients have been studied to a limited degree. We evaluated whether patients heterozygous for a FVL mutation undergoing deep inferior epigastric perforator flap reconstruction had increased risk of micro- or macrovascular thrombotic complications compared with patients without a diagnosed thrombophilia.

Methods:
We performed a retrospective cohort study of deep inferior epigastric perforator flap reconstructions at Brigham and Women’s Hospital (1/2015–12/2020) comparing patients diagnosed as FVL heterozygotes compared with matched controls without a diagnosed thrombophilia. Patients were matched using coarsened exact matching algorithm based on clinical characteristics. The primary outcomes were micro- (return to OR for flap compromise, flap loss) and macrovascular (venous thromboembolism) complications.

Results:
A total of 506 patients (812 flaps) were included in this study. Eleven patients (17 flaps) were FVL heterozygotes. After matching, 10 patients (16 flaps) with FVL were matched to 55 patients (94 flaps). The return to OR for flap compromise was 0% in the FVL cohort compared with 5% (n = 5/94, 3/94 flaps lost, P = 1.00) in the matched controls (1.9%, n = 15/795 in unmatched controls, 0.6%, n = 5/795 loss rate). There were zero venous thromboembolism events among FVL patients compared with 2% of controls (n = 1/55).

Conclusions:
FVL heterozygosity did not increase the risk of micro- or macrovascular complications in patients undergoing deep inferior epigastric perforator flap breast reconstruction. This study supports the safety of microvascular reconstruction in this group of patients when appropriate venous thromboembolism prophylaxis is given.
Use of Needle Localization in the Surgical Management of Non-seroma, Mass-forming BIA-ALCL
Authors: Kim David H. , Webster Theresa K. , Bartolacci Joseph G. , Araya Sthefano , Panichella Juliet , Patel Sameer A. 
Published: April 2022

Summary:
Outcomes related to the treatment of breast implant-associated anaplastic large cell lymphoma, a rare extranodal T-cell lymphoma associated with textured breast implants, are largely dependent on the successful resection to negative margins via en bloc capsulectomy and resection of any associated masses. To date, the use of needle localization, a common technique used in breast surgery, to assist in the complete removal of breast implant-associated anaplastic large cell lymphoma has not been described. We present the case report of a 66-year-old woman, with a previous medical history of left-sided invasive ductal carcinoma, who presented 7 years after textured breast implant placement with a left-sided mass without peri-implant seroma. Biopsy demonstrated breast implant-associated anaplastic large cell lymphoma and the associated breast mass extended beyond the capsule borders. The present report describes the novel use of needle localization in this patient to facilitate the complete removal of the malignancy-associated mass with maximal preservation of the overlying soft tissue envelope.
CaV3.2 calcium channels contribute to trigeminal neuralgia
Authors: Gambeta Eder , Gandini Maria A. , Souza Ivana A. , Zamponi Gerald W. 
Published: April 2022

Abstract
Trigeminal neuralgia (TN) is a rare but debilitating disorder characterized by excruciating facial pain, with a higher incidence in women. Recent studies demonstrated that TN patients present mutations in the gene encoding the CaV3.2 T-type calcium channel, an important player in peripheral pain pathways. We characterize the role of CaV3.2 channels in TN at 2 levels. First, we examined the biophysical properties of CACNA1H variants found in TN patients. Second, we investigated the role of CaV3.2 in an animal model of trigeminal neuropathic pain. Whole-cell patch-clamp recordings from 4 different mutants expressed in tsA-201 cells (E286K in the pore loop of domain I, H526Y, G563R, and P566T in the domain I-II linker) identified a loss of function in activation in the E286K mutation and gain of function in the G563R and P566T mutations. Moreover, a loss of function in inactivation was observed with the E286K and H526Y mutations. Cell surface biotinylation revealed no difference in channel trafficking among the variants. The G563R mutant also caused a gain of function in the firing properties of transfected trigeminal ganglion neurons. In female and male mice, constriction of the infraorbital nerve induced facial thermal heat hyperalgesia. Block of T-type channels with Z944 resulted in antihyperalgesia. The effect of Z944 was absent in CaV3.2−/− mice, indicating that CaV3.2 is the molecular target of the antihyperalgesic Z944 effect. Finally, enzyme-linked immunosorbent assay analysis revealed increased CaV3.2 channel expression in the spinal trigeminal subnucleus caudalis. Altogether, the present study demonstrates an important role of CaV3.2 channels in trigeminal pain.
Nursing Care Experiences With Syrian Refugees in Southern Turkey: A Metaphor Analysis
Authors: AKGÜL-GÜNDOĞDU Nurcan , TAŞ Filiz , SELÇUK-TOSUN Alime 
Published: April 2022

ABSTRACT

Background
Healthcare professionals' “cultural prejudices” toward individuals' cultural beliefs, attitudes, and perceptions affect the care they provide. Their awareness of their bias is closely associated with the quality of healthcare provided.

Purpose
This study was designed to assess nurses' perceptions regarding providing care to Syrian refugee patients using metaphors and to evaluate their views based on these metaphors.

Methods
The participants in this qualitative study consisted of 80 nurses who worked in Level 1 and Level 2 health institutions. Data were collected using an interview form prepared by the researchers. The form included descriptive characteristics of the nurses and two expressions used to determine the nurses' opinions on providing care for Syrian refugee patients. The nurses were given an incomplete sentence, which was “Providing care for a Syrian refugee patient…because…,” and were asked to complete the blanks. The data were analyzed using the content analysis method.

Results
On the basis of “providing care for Syrian refugee patients,” four categories of metaphors were determined: occupational awareness, health promotion, a difficult process/resistance, and providing service in vain. The participants generated 50 metaphors, with “humanity,” “a baby/little child,” and “a barrier” as the three most used metaphors, belonging to the “occupational awareness” and “a difficult process/resistance” categories, respectively.

Conclusions/Implications for Practice
The metaphors of nurses regarding giving care to Syrian refugee patients were mostly concentrated in the categories of “occupational awareness” and “a difficult process/resistance.” Metaphors generated by the nurses offer a powerful research tool to reveal, understand, and explain nurses' personal perceptions and to develop and support nursing care accordingly. In addition, the subject of transcultural nursing should be discussed more extensively in nursing education programs. Understanding the social context of refugees is very important during the nursing care process.
Academic Entitlement and Its Potential Educational Consequences: A Scoping Review
Authors: Kinne Bonni Lynn , Goehring Meri Tienn , Lee Williams Betsy 
Published: April 2022

Background and Purpose.
In 2020, the first and only study to investigate academic entitlement in doctor of physical therapy (DPT) students was published. In the review of literature section of the study, the authors alluded to the premise that academic entitlement seems to be directly related to several educational consequences. The purpose of this scoping review was to determine what educational consequences may result from increased academic entitlement, especially as they relate to DPT students.

Methods.
A scoping review was conducted to systematically identify what is known about the correlation between academic entitlement and its educational consequences. The scoping review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist.

Results.
A total of 25 studies were included in the scoping review. For ease of interpretation, the authors organized the statistically significant findings into content areas composed of learning processes related to academic confidence, learning processes related to academic preferences, learning outcomes related to self, and learning outcomes related to others.

Discussion and Conclusion.
This scoping review determined that several educational consequences may result from increased academic entitlement. A few of the educational factors related to increased academic entitlement also led to adverse personal consequences for both students and their faculty members. Future research should include a review that determines all the possible causes of increased academic entitlement. This information would be beneficial to instructors involved in all levels of education, including faculty members employed in a DPT program.
Endoscopic Submucosal Dissection (ESD) Offers a Safer and More Cost-effective Alternative to Transanal Endoscopic Microsurgery (TEM)
Authors: Kim Marina , Bareket Romy , Eleftheriadis Nikolas P. , Kedia Prashant , Seewald Stefan , Groth Stefan , Nieto Jose , Kumta Nikhil A. , Deshmukh Ameya A. , Katz Jordan , Suresh Supriya , Zamarripa Felipe , Martínez Ma Guadalupe , Liu-Burdowski Jennifer , Gaidhane Monica , Sarkar Avik , Shahid Haroon M. , Tyberg Amy , Kahaleh Michel 
Published: April 2022

Background:
Endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) are minimally invasive procedures that treat early rectal cancer (ERC). Both are effective treatments, yet there are very few studies comparing them. The aim of our study was to identify ideal candidates for each procedure.

Materials and Methods:
Between January 2016 and November 2019, 204 ERC patients were managed with either ESD (n=101) or TEM (n=103) at 7 international centers. Data analyzed included clinical success, tumor characteristics, procedure info, and recurrence rates.

Results:
Median tumor size was 40 mm±23.9 in the ESD group and 56 mm±27.9 in the TEM group, significantly larger in the latter (P<0.00001). Average procedure time was 131.5±67.9 minutes in ESD group and 104.9±28.4 minutes in TEM group (P=0.000347). Average hospital stay was 3.3±2.6 days in the ESD group and 4.7±0.7 days in the TEM group (P<0.00001). Adverse event rate was 6.8% in the ESD group and 24% in the TEM group. There were no significant difference in the rate of en bloc resection, technical success, tumor location, necessity of additional procedures, and tumor recurrence rates.

Conclusion:
Compared with TEM, ESD is a safer procedure with shorter hospital stay and should be offered for patients who have ERC.
Study Protocol to Evaluate Influences of Stress and Inflammation on Mucositis in Adolescents and Young Adults With Cancer
Authors: Thornton Clifton P. , Kozachik Sharon , Ruble Kathy 
Published: April 2022

Background
Adolescent and young adult (AYA) cancer diagnoses are rising, and gains in survivorship are falling behind for this age group. Dose-limiting toxicities of therapy, including mucositis, are more frequent in this age group and may be contributing to poorer survivorship. Animal models and observational studies suggest that stress and inflammation may be contributing to the high prevalence of dose-limiting mucositis in this age demographic. The AYA oncology population has been an overlooked and underresearched oncology demographic, leading to poor understanding of why this age group has high side-effect burdens and poorer cancer survival.

Objectives
This article describes a novel, prospective clinical study in AYAs receiving chemotherapy designed to evaluate if stress at the time of chemotherapy administration predicts the development of dose-limiting mucositis and determines if stress-induced inflammatory profiles mediate this relationship. This is the first study to translate these stress and inflammation findings from animal models to a nurse-centered research design in humans.

Methods
Persons aged 15–39 years who are receiving chemotherapy with a significant (>20%) risk of developing mucositis will be recruited for a prospective study. Baseline stress is measured through participant questionnaires, and blood is collected to analyze for inflammatory markers. Participants receive chemotherapy as clinically planned and complete a daily survey of mucositis symptoms for 14 days after chemotherapy. Regression and mediation analysis will determine if stress and inflammatory profiles predict the development of dose-limiting mucositis.

Results
This model of inquiry through a nursing framework uses a biobehavioral model that considers physiological and psychological risk factors for chemotherapy toxicities. This study is also an important translational science study essential in bringing data from laboratory studies to the clinical arena. The study may also be important to implementation science because assessing the ability of critically ill individuals to participate in low-burden clinical studies may yield essential findings to improve care delivery.

Discussion
Findings from this work will identify potentially modifiable factors that may be manipulated to minimize chemotherapy toxicities and lead to improved survival. Data from this study will inform larger research endeavors to better understand symptom development in this high-risk oncological population.
Spatial Access to Sexual Health Clinics Measured Through a Novel Accessibility Score in Toronto, Canada
Authors: Wang Susan , Widener Michael , Burchell Ann N. , Grace Daniel , Gesink Dionne 
Published: April 2022

Background
Understanding spatial access to sexual health services will provide the foundation for future resource planning and allocation. The purpose of this study was to evaluate the potential geographic access to sexual health services in Toronto, Canada, by developing a novel accessibility index to sexual health clinics.

Methods
We created an accessibility index using the 2-step floating catchment area method to quantify neighborhood-level access to sexual health clinics. The index assumed mixed modes of urban travel through walking and public transit, as well as through driving, and was estimated at the census tract level.

Results
Census tracts were grouped into quantiles by the estimated accessibility score. Census tracts with higher accessibility scores were characterized as those with greater residential instability and lower dependency and ethnic concentration. The downtown core area has all census tracts categorized as medium, high, or very high (average [SD] score, 1.320 [0.312]), whereas the noncore area has 56.98%, 302 of 530 census tracts categorized as medium, high, or very high (average [SD] score, −0.105 [0.960]).

Conclusions
We demonstrated the benefit of using statistical methods to quantify the geographical access to sexual health services and identified neighborhoods with high and low levels of access. Findings from this study present an overview of the level of spatial access to sexual health clinics in Toronto based on clinic locations in 2018 and can be further used to characterize neighborhoods with a lower level of access and inform policy and planning decisions in the city.
Impact of the COVID-19 Pandemic on Chlamydia and Gonorrhea Tests Performed by a Large National Laboratory—United States, 2019 to 2020
Authors: Tao Guoyu , Dietz Stephanie , Hartnett Kathleen P. , Jayanthi Praveena , Gift Thomas L. 
Published: April 2022

Background
During the COVID-19 pandemic, disruptions were anticipated in the US health care system for routine preventive and other nonemergency care, including sexually transmitted infection care.

Methods
Using a large national laboratory data set, we assessed the impact of the COVID-19 pandemic on the weekly numbers and percent positivity of chlamydia and gonorrhea tests ordered from the 5th week of 2019 to the 52nd week of 2020 in the United States. We compared weekly 2020 values for test volume, percent positive, and number of positives with the same week in 2019. We also examined the potential impact of stay-at-home orders for the month of April 2020.

Results
Immediately after the declaration of a national emergency for COVID-19 (week 11, 2020), the weekly number of gonorrhea and chlamydia tests steeply decreased. Tests then rebounded toward the 2019 pre–COVID-19 level beginning the 15th week of 2020. The weekly percent positive of chlamydia and gonorrhea remained consistently higher in 2020. In April 2020, the overall number of chlamydia tests was reduced by 53.0% (54.1% in states with stay-at-home orders vs. 45.5% in states without stay-at-home orders), whereas the percent positive of chlamydia and gonorrhea tests increased by 23.5% and 79.1%, respectively.

Conclusions
To limit the impact of the pandemic on control of chlamydia and gonorrhea, public health officials and health care providers can assess measures put in place during the pandemic and develop new interventions to enable care for sexually transmitted infections to be delivered under pandemic and other emergency conditions. The assessment like this study is continuously needed.