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Obstructed hemivagina with ipsilateral renal anomaly (OHVIRA) is a rare congenital genitourinary defect with a triad of unilateral vaginal obstruction, uterine anomaly and ipsilateral renal agenesis. This paper reports an unusual presentation of OHVIRA, with our patient experiencing severe abdominal pain from a left tubo-ovarian abscess that is contralateral to the side of the vaginal outflow obstruction. Another reportable finding is our patient’s rare association of a trifid ureter that fuses distally before inserting ectopically in her vaginal canal. Lastly, this case report also emphasises the importance of radiologists’ expertise in suspecting the diagnosis early on and in contributing to the preoperative evaluation of patients with OHVIRA, thereby providing adequate management for these patients.

Purpose: Preclinical data showed that prophylactic, low-dose temozolomide (TMZ) significantly prevented breast cancer brain metastasis. We present results of a phase I trial combining T-DM1 with TMZ for the prevention of additional brain metastases after previous occurrence and local treatment in patients with HER2+ breast cancer. Patients and Methods: Eligible patients had HER2+ breast cancer with brain metastases and were within 12 weeks of whole brain radiation therapy (WBRT), stereotactic radiosurgery, and/or surgery. Standard doses of T-DM1 were administered intravenously every 21 days (3.6 mg/kg) and TMZ was given orally daily in a 3+3 phase I dose escalation design at 30, 40, or 50 mg/m2, continuously. DLT period was one 21-day cycle. Primary endpoint was safety and recommended phase II dose. Symptom questionnaires, brain MRI, and systemic CT scans were performed every 6 weeks. Cell-free DNA sequencing was performed on patients’ plasma and CSF. Results: Twelve women enrolled, nine (75%) with prior SRS therapy and three (25%) with prior WBRT. Grade 3 or 4 AEs included thrombocytopenia (1/12), neutropenia (1/12), lymphopenia (6/12), and decreased CD4 (6/12), requiring pentamidine for Pneumocystis jirovecii pneumonia prophylaxis. No DLT was observed. Four patients on the highest TMZ dose underwent dose reductions. At trial entry, 6 of 12 patients had tumor mutations in CSF, indicating ongoing metastatic colonization despite a clear MRI. Median follow-up on study was 9.6 m (2.8–33.9); only 2 patients developed new parenchymal brain metastases. Tumor mutations varied with patient outcome. Conclusions: Metronomic TMZ in combination with standard dose T-DM1 shows low-grade toxicity and potential activity in secondary prevention of HER2+ brain metastases.

The pre-industrial state of the global carbon cycle is a significant aspect of studies related to climate change. In this paper, we recall the power law kinetic representations of the pre-industrial models of Schmitz (2002) and Anderies et al. (2013) from our earlier work. The power law kinetic representations, as uniform formalism, allow for a more extensive analysis and comparison of the different models for the same system. Using the mathematical theories of chemical reaction networks (with power-law kinetics), this work extends the analysis of the kinetic representations of the two models and assesses the similarities and differences in their structural and dynamic properties in relation to model construction assumptions. The analysis includes but is not limited to the coincidence of kinetic and stoichiometric spaces of the networks, capacity for equilibria multiplicity and co-multiplicity, and absolute concentration robustness in some species. Moreover, we bring together previously published results about the power law kinetic representations of the two models and consolidate them with new observations here. We also illustrate how the pre-industrial model of Anderies et al. may serve as a building block in the analysis of a kinetic representation of a global carbon cycle with carbon dioxide removal intervention., arXiv admin note: text overlap with arXiv:1109.2923 by other authors

Studies about the set of positive equilibria ($E_+$) of kinetic systems have been focused on mass action, and not that much on power law kinetic (PLK) systems, even for PL-RDK systems (PLK systems where two reactions with identical reactant complexes have the same kinetic order vectors). For mass action, reactions with different reactants have different kinetic order rows. A PL-RDK system satisfying this property is called factor span surjective (PL-FSK). In this work, we show that a cycle terminal PL-FSK system with $E_+\ne \varnothing$ and has independent linkage classes (ILC) is a poly-PLP system, i.e., $E_+$ is the disjoint union of log-parametrized sets. The key insight for the extension is that factor span surjectivity induces an isomorphic digraph structure on the kinetic complexes. The result also completes, for ILC networks, the structural analysis of the original complex balanced generalized mass action systems (GMAS) by M\"uller and Regensburger. We also identify a large set of PL-RDK systems where non-emptiness of $E_+$ is a necessary and sufficient condition for non-emptiness of each set of positive equilibria for each linkage class. These results extend those of Boros on mass action systems with ILC. We conclude this paper with two applications of our results. Firstly, we consider absolute complex balancing (ACB), i.e., the property that each positive equilibrium is complex balanced, in poly-PLP systems. Finally, we use the new results to study absolute concentration robustness (ACR) in these systems. In particular, we obtain a species hyperplane containment criterion to determine ACR in the system species.

In the tripartite influence model, appearance-ideal internalization is identified as a prominent risk factor for the development of body dissatisfaction and subsequent eating disorder (ED) behaviors. For men, prior research has emphasized the importance of both thin-ideal internalization and muscular-ideal internalization in explaining later ED behaviors and muscle dysmorphia (MD) symptoms. Previous research in heterosexual men has shown that the associations between muscular-ideal internalization and ED or MD symptoms may depend on whether the individual has also internalized the thin ideal. However, this interaction has not been examined in research with sexual minority men (SMM).The current study collected self-report data from 452 at risk SMM (i.e., endorsed body dissatisfaction), with ages ranging from 18 to 35 years. Linear regression models were conducted to test the interaction effects between thinness and muscularity internalization on ED symptoms, MD behaviors, and general body dissatisfaction. Simple slopes and the Johnson-Neyman technique were used to investigate significant interaction terms.Thin- and muscular-ideal internalization were positively associated with muscular appearance intolerance and dietary restriction with no significant interaction. Muscular drive for size was highest when both muscularity internalization and thinness internalization were high. Muscular-ideal internalization was positively associated with both cognitive restraint and general body dissatisfaction, but only at lower levels of thinness internalization.Given the interacting association between thinness and muscularity internalization and aspects of body dissatisfaction, attitudes, and behavior, prevention and intervention programs for EDs and MDs in SMM should seek to dismantle both thinness and muscularity internalization.Internalizing-or adopting as one's own-the ideal of a body with low body fat and high muscularity has been shown to lead to muscle dysmorphia and eating disorder symptoms in men. The current study examines whether the combination of thin-ideal and muscular-ideal internalization is associated with worse symptoms than either facet alone in sexual minority men. Treatment efforts in sexual minority men should address both types of internalization.

Objetivo. Presentar el diseño de la Encuesta Nacional de Salud y Nutrición (Ensanut) 2022 y cuantificar el avance de la Ensanut Continua 2020-2024. Material y métodos. La Ensanut 2022 es la tercera encuesta de la serie de en­cuestas denominada Ensanut Continua 2020-2024. En este documento se describe el alcance de la Ensanut 2022 y sus procedimientos de muestreo, medición y organización logís­tica. Además, se presenta el avance esperado de la Ensanut Continua 2020-2024 al concluir la Ensanut 2022. Resulta­dos. La Ensanut 2022 obtendrá, a nivel nacional, al menos 10 160 entrevistas completas de hogar y 9 441 resultados de seropositividad a SARS-CoV-2. Conclusiones. La Ensanut 2022 estimará la prevalencia de seropositividad a SARS-CoV-2 a nivel nacional y regional y avanzará en la acumulación de información para alcanzar los objetivos de la Ensanut Con­tinua 2020-2024.

Background Symptom expression in SARS-CoV-2 infection (COVID-19) may affect patients already symptomatic with cancer. Patient-reported outcomes (PROs) can describe symptom burden during the acute and postacute stages of COVID-19 and support risk stratification for levels of care. At the start of the COVID-19 pandemic, our purpose was to rapidly develop, launch through an electronic patient portal, and provide initial validation for a PRO measure of COVID-19 symptom burden in patients with cancer. Methods We conducted a CDC/WHO web-based scan for COVID-19 symptoms and a relevance review of symptoms by an expert panel of clinicians treating cancer patients with COVID-19 to create a provisional MD Anderson Symptom Inventory for COVID-19 (MDASI-COVID). English-speaking adults with cancer who tested positive for COVID-19 participated in the psychometric testing phase. Patients completed longitudinal assessments of the MDASI-COVID and the EuroQOL 5 Dimensions 5 Levels (EQ-5D-5L) utility index and visual analog scale, which were presented through an electronic health record patient portal. To test the validity of the MDASI-COVID to distinguish between known groups of patients, we hypothesized that patients hospitalized, including having a hospitalization extended, for COVID-19 versus those not hospitalized would experience higher symptom burden. Correlation of mean symptom severity and interference scores with relevant EQ-5D-5L scores tested concurrent validity. The reliability of the MDASI-COVID was evaluated by calculating Cronbach alpha coefficients and test-retest reliability was evaluated by calculating Pearson correlation coefficients between the initial assessment and a second assessment no more than 14 days later. Results The web-based scan found 31 COVID-19-related symptoms; rankings of a 14-clinician expert panel reduced this list to 11 COVID-specific items to be added to the core MDASI. Time from literature scan start in March 2020 to instrument launch in May 2020 was 2 months. Psychometric analysis established the MDASI-COVID’s reliability, known-group validity, and concurrent validity. Conclusions We were able to rapidly develop and electronically launch a PRO measure of COVID-19 symptom burden in patients with cancer. Additional research is needed to confirm the content domain and predictive validity of the MDASI-COVID and define the symptom burden trajectory of COVID-19.

Introduction Immune checkpoint inhibitor (ICI) pneumonitis causes substantial morbidity and mortality. Estimates of real-world incidence and reported risk factors vary substantially. Methods We conducted a retrospective review of 419 patients with advanced non-small cell lung cancer (NSCLC) who were treated with anti-PD-(L)1 with or without anti-CTLA-4 therapy. Clinical, imaging, and microbiological data were evaluated by multidisciplinary adjudication teams. The primary outcome of interest was grade ≥2 (CTCAEv5) pneumonitis. Clinicopathologic variables, tobacco use, cancer therapies, and preexisting lung disease were assessed for univariate effects using Cox proportional hazards models. We created multivariate Cox proportional hazards models to assess risk factors for pneumonitis and mortality. Pneumonitis, pneumonia, and progression were modeled as time-dependent variables in mortality models. Results We evaluated 419 patients between 2013 and 2021. The cumulative incidence of pneumonitis was 9.5% (40/419). In a multivariate model, pneumonitis increased the risk for mortality (HR 1.6, 95% CI, 1.0-2.5), after adjustment for disease progression (HR 1.6, 95% CI, 1.4-1.8) and baseline shortness of breath (HR 1.5, 95% CI, 1.2-2.0). Incomplete resolution was more common with more severe pneumonitis. Interstitial lung disease was associated with higher risk for pneumonitis (HR 5.4, 95% CI, 1.1-26.6), particularly in never smokers (HR 26.9, 95% CI, 2.8-259.0). Conclusion Pneumonitis occurred at a high rate and significantly increased mortality. Interstitial lung disease, particularly in never smokers, increased the risk for pneumonitis.

Synthesis, X-ray crystallography, spectral analysis, and molecular docking analysis on (E)–2–(1–(4–fluorophenyl) ethylidene) hydrazine carbothioamide (EFEHC) are performed. Thiosemicarbazones are a class of small molecules used as anticancer therapeutics. The FT–IR and FT-Raman spectra of EFEHC have been recorded in 4000–400 and 4000–100 cm–1, respectively. The present communication deals with the quantum chemical calculations of energies, geometrical structure, and vibrational wavenumbers of EFEHC using the density functional (DFT/B3LYP) method with 6–31G (d, p) basis set. The conformational analysis gives the energy values based on the change in the position of atoms in the EFEHC molecule. Hirshfeld surface analysis (HSs) is used to discuss the evaluation of intermolecular interactions. Molecular docking analysis of the small molecule EFEHC with macromolecule HMG–CoA protein showed that this is a good molecule and is suitable for anti-cholesterol targets.

Supplemental Fig 2. Total mutation Burden by MB.

Purpose:Preclinical data showed that prophylactic, low-dose temozolomide (TMZ) significantly prevented breast cancer brain metastasis. We present results of a phase I trial combining T-DM1 with TMZ for the prevention of additional brain metastases after previous occurrence and local treatment in patients with HER2+ breast cancer.Patients and Methods:Eligible patients had HER2+ breast cancer with brain metastases and were within 12 weeks of whole brain radiation therapy (WBRT), stereotactic radiosurgery, and/or surgery. Standard doses of T-DM1 were administered intravenously every 21 days (3.6 mg/kg) and TMZ was given orally daily in a 3+3 phase I dose escalation design at 30, 40, or 50 mg/m2, continuously. DLT period was one 21-day cycle. Primary endpoint was safety and recommended phase II dose. Symptom questionnaires, brain MRI, and systemic CT scans were performed every 6 weeks. Cell-free DNA sequencing was performed on patients’ plasma and CSF.Results:Twelve women enrolled, nine (75%) with prior SRS therapy and three (25%) with prior WBRT. Grade 3 or 4 AEs included thrombocytopenia (1/12), neutropenia (1/12), lymphopenia (6/12), and decreased CD4 (6/12), requiring pentamidine for Pneumocystis jirovecii pneumonia prophylaxis. No DLT was observed. Four patients on the highest TMZ dose underwent dose reductions. At trial entry, 6 of 12 patients had tumor mutations in CSF, indicating ongoing metastatic colonization despite a clear MRI. Median follow-up on study was 9.6 m (2.8–33.9); only 2 patients developed new parenchymal brain metastases. Tumor mutations varied with patient outcome.Conclusions:Metronomic TMZ in combination with standard dose T-DM1 shows low-grade toxicity and potential activity in secondary prevention of HER2+ brain metastases.

Supplemental Methods

Neutrophils chemotaxis video

Clinical trial protocol

Supplementary Figures and Tables

Purpose:To investigate the toxicity profile and establish an optimal dosing schedule of zotiraciclib with temozolomide in patients with recurrent high-grade astrocytoma.Patients and Methods:This two-stage phase I trial determined the MTD of zotiraciclib combined with either dose-dense (Arm1) or metronomic (Arm2) temozolomide using a Bayesian Optimal Interval design; then a randomized cohort expansion compared the progression-free survival rate at 4 months (PFS4) of the two arms for an efficient determination of a temozolomide schedule to combine with zotiraciclib at MTD. Pharmacokinetic and pharmacogenomic profiling were included. Patient-reported outcome was evaluated by longitudinal symptom burden.Results:Fifty-three patients were enrolled. Dose-limiting toxicities were neutropenia, diarrhea, elevated liver enzymes, and fatigue. MTD of zotiraciclib was 250 mg in both arms and thus selected for the cohort expansion. Dose-dense temozolomide plus zotiraciclib (PSF4 40%) compared favorably with metronomic temozolomide (PFS4 25%). Symptom burden worsened at cycle 2 but stabilized by cycle 4 in both arms. A significant decrease in absolute neutrophil count and neutrophil reactive oxygen species production occurred 12–24 hours after an oral dose of zotiraciclib but both recovered by 72 hours. Pharmacokinetic/pharmacogenomic analyses revealed that the CYP1A2_5347T>C (rs2470890) polymorphism was associated with higher AUCinf value.Conclusions:Zotiraciclib combined with temozolomide is safe in patients with recurrent high-grade astrocytomas. Zotiraciclib-induced neutropenia can be profound but mostly transient, warranting close monitoring rather than treatment discontinuation. Once validated, polymorphisms predicting drug metabolism may allow personalized dosing of zotiraciclib.

Purpose The standard recall period for the patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE®) is the past 7 days, but there are contexts where a 24-hour recall may be desirable. The purpose of this analysis was to investigate the reliability and validity of a subset of PRO-CTCAE items captured using a 24-hour recall. Methods 27 PRO-CTCAE items representing 14 symptomatic adverse events (AEs) were collected using both a 24-hour recall (24 h) and the standard 7 day recall (7d) in a sample of patients receiving active cancer treatment (n = 113). Using data captured with a PRO-CTCAE-24h on days 6 and 7, and 20 and 21, we computed intra-class correlation coefficients (ICC); an ICC ≥ 0.70 was interpreted as demonstrating high test–retest reliability. Correlations between PRO-CTCAE-24h items on day 7 and conceptually relevant EORTC QLQ-C30 domains were examined. In responsiveness analysis, patients were deemed changed if they had a one-point or greater change in the corresponding PRO-CTCAE-7d item (from week 0 to week 1). Results PRO-CTCAE-24h captured on two consecutive days demonstrated that 21 of 27 items (78%) had ICCs ≥ 0.70 (day 6/7 median ICC 0.76), (day 20/21 median ICC 0.84). Median correlation between attributes within a common AE was 0.75, and the median correlation between conceptually relevant EORTC QLQ-C30 domains and PRO-CTCAE-24 h items captured on day 7 was 0.44. In the analysis of responsiveness to change, the median standardized response mean (SRM) for patients with improvement was − 0.52 and that for patients with worsening was 0.71. Conclusion A 24-hour recall period for PRO-CTCAE items has acceptable measurement properties and can inform day-to-day variations in symptomatic AEs when daily PRO-CTCAE administration is implemented in a clinical trial.

Vertical-axis wind turbines (VAWTs) have a long history, with a wide variety of turbine archetypes that have been designed and tested since the 1970s. While few utility-scale VAWTs currently exist, the placement of the generator near the turbine base could make VAWTs advantageous over tradition horizontal-axis wind turbines for floating offshore wind applications via reduced platform costs and improved scaling potential. However, there are currently few numerical design and analysis tools available for VAWTs. One existing engineering toolset for aero-hydro-servo-elastic simulation of VAWTs is the Offshore Wind ENergy Simulator (OWENS), but its current modeling capability for floating systems is non-standard and not ideal. This article describes how OWENS has been coupled to several OpenFAST modules to update and improve modeling of floating offshore VAWTs and discusses the verification of these new capabilities and features. The results of the coupled OWENS verification test agree well with a parallel OpenFAST simulation, validating the new modeling and simulation capabilities in OWENS for floating VAWT applications. These developments will enable the design and optimization of floating offshore VAWTs in the future.

Immune checkpoint inhibitors (ICI), combined with hypomethylating agents, can be used to treat acute myeloid leukemia (AML), but this strategy results in a high rate of pneumonitis. The authors sought to determine risk factors for pneumonitis development and whether pneumonitis increased mortality.The authors conducted a retrospective review of 258 AML patients who received ICI-containing regimens from 2016 to 2018. A multidisciplinary adjudication committee diagnosed pneumonia and pneumonitis by reviewing symptoms, imaging, microbiology, and response to therapies. To measure risk factors for pneumonitis and mortality, multivariate Cox proportional hazards models were constructed. Pneumonia, pneumonitis, and disease progression were modeled as a time-dependent variable and incorporated a standard risk set modifying variables into the models.Thirty patients developed pneumonitis (12%). Of these, 17 had partial or complete resolution, whereas 13 patients died from pneumonitis. Increasing age (hazard ratio [HR], 1.04 per year; 95% confidence interval [CI], 1.00-1.08), and baseline shortness of breath increased pneumonitis risk (HR, 2.51; 95% CI, 1.13-5.55). Female sex (HR, 0.33; 95% CI, 0.15-0.70) and increasing platelet count (HR, 0.52 per log-unit increase; 95% CI, 0.30-0.92) decreased pneumonitis risk. In adjusted models, ICI-related pneumonitis significantly increased mortality (HR, 2.84; 95% CI, 1.84-4.37).ICI-related pneumonitis occurs at a high rate in AML patients and increases mortality.Immune checkpoint inhibitors (ICIs) remove inhibitory signals that reduce T-cell function and allow T-cells to better attack cancer cells. In acute myeloid leukemia (AML), the effectiveness of ICIs is limited in part by inflammation of the lung, called pneumonitis. This study reviewed 258 patients with AML who received ICIs and identified 30 patients who developed pneumonitis, nearly half of whom died. Older age and baseline shortness of breath increased pneumonitis risk, whereas female sex and higher baseline platelet counts decreased pneumonitis risk. Pneumonitis increased mortality by nearly 3-fold. This work highlights the significant harm imposed by pneumonitis after ICI therapies.

This paper studies chemical kinetic systems which decompose into weakly reversible complex factorizable (CF) systems. Among power law kinetic systems, CF systems (denoted as PL-RDK systems) are those where branching reactions of a reactant complex have identical rows in the kinetic order matrix. Mass action and generalized mass action systems (GMAS) are well-known examples. Schmitz's global carbon cycle model is a previously studied non-complex factorizable (NF) power law system (denoted as PL-NDK). We derive novel conditions for the existence of weakly reversible CF-decompositions and present an algorithm for verifying these conditions. We discuss methods for identifying independent decompositions, i.e., those where the stoichiometric subspaces of the subnetworks form a direct sum, as such decompositions relate positive equilibria sets of the subnetworks to that of the whole network. We then use the results to determine the positive equilibria sets of PL-NDK systems which admit an independent weakly reversible decomposition into PL-RDK systems of PLP type, i.e., the positive equilibria are log-parametrized, which is a broad generalization of a Deficiency Zero Theorem of Fortun et al. (2019).

Communities of color have been disproportionately impacted by the coronavirus disease (COVID-19) pandemic, exposing the influence of decades of policies that have under-resourced and marginalized these communities. The history of segregation and inadequate funding in education has been exacerbated by the pandemic, compounding the educational inequities already present in the United States. The intersection of this inequity alongside immigration policies over the past years have led the undocumented student population to be adversely impacted. The lack of access to health care and social safety net programs, fear of deportation, and an over reliance on technology for schooling leaves a large segment of students vulnerable for adverse academic, emotional, and social outcomes. This paper will trace the historical path of educational segregation, immigration policies, and how these led to the disproportionate impact of COVID-19 on undocumented students. It will discuss interventions for undocumented students within an antioppressive ecological framework and the ethical responsibilities that school-based mental health professionals have to support undocumented students to fulfill their highest potential, manage the emotional toll of the pandemic, and advocate for change in immigration and educational policies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).