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Lisbet Grønbæk,1– 3 Harmony Omeife,3 Lu Ban,4 Colin J Crooks,5 Timothy R Card,3,4 Peter Jepsen,1,3 Joe West3,4,6 1Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark; 2Department of Medicine, Regional Hospital Horsens, Horsens, Denmark; 3Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK; 4National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, the Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK; 5Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK; 6Department of Clinical Medicine, Aarhus University, Aarhus, DenmarkCorrespondence: Lisbet Grønbæk, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus, 8200, Denmark, Tel +45 78450000, Fax +45 78453897, Email Lisbet.Groenbaek@clin.au.dkPurpose: Smoking is a risk factor for some autoimmune diseases, but its association with autoimmune hepatitis remains unknown. We conducted a population-based matched case–control study to examine the association between tobacco smoking and the risk of autoimmune hepatitis in England.Patients and Methods: From the Clinical Practice Research Datalink and linked Hospital Episode Statistics, 2005– 2017, we included 987 cases diagnosed with autoimmune hepatitis after age 18 years and up to 10 frequency-matched population controls per case. We used multiple logistic regression to estimate the odds ratio of autoimmune hepatitis in ever-smokers vs never-smokers, adjusting for sex, age, general practice, calendar time of registration with the general practice, and socioeconomic status.Results: The autoimmune hepatitis cases were more likely to be ever-smokers than the controls (44% vs 37%). The ever-smokers had an increased risk of autoimmune hepatitis compared with the never-smokers (adjusted odds ratio = 1.20, 95% confidence interval 1.

Weily Soong,1 Bradley E Chipps,2 Warner Carr,3 Jennifer Trevor,4 Arpan Patel,5 Nicole Clarke,6 Donna D Carstens,5 Christopher S Ambrose6 1AllerVie Health, AllerVie Clinical Research, Birmingham, AL, USA; 2Capital Allergy & Respiratory Disease Center, Sacramento, CA, USA; 3Allergy & Asthma Associates of Southern California, Food Allergy Center of Southern California, Mission Viejo, CA, USA; 4Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; 5BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, USA; 6BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USACorrespondence: Christopher S Ambrose, BioPharmaceuticals Medical, AstraZeneca, One MedImmune Way, Gaithersburg, MD, 20878, USA, Tel +1 301-398-4454, Email chris.ambrose@astrazeneca.comPurpose: Patients living with severe asthma (SA) experience multiple health-related quality of life (HRQoL) impairments. This study examined HRQoL changes after biologic treatment initiation among a large, real-world cohort of patients with SA.Patients and methods: CHRONICLE is an ongoing observational study of subspecialist-treated adults with SA who receive biologics or maintenance systemic corticosteroids or are uncontrolled on high-dosage inhaled corticosteroids with additional controllers. Patients enrolled February 2018–February 2023 were asked to complete the St. George’s Respiratory Questionnaire (SGRQ) every 6 months (total score range of 0– 100 [0=best possible health], meaningful change threshold is a 4-unit reduction in the total score). Changes in SGRQ responses from 6 months before initiation to 12 to 18 months after initiation were summarized.Results: A total of 76 patients completed the SGRQ 0 to 6 months before and 12 to 18 months after biologic initiation. The mean (SD) SGRQ total score decreased from 52.2 (20.6) to 41.9 (23.8), with improvement across the symptoms (− 14.5), activity (− 11.0), and impacts (− 8.3) componen

Anthony D Andre,1 John F Mohr,2 Barbara W Cornelius,2 Matthew M Goodwin,2 Carson P Whitaker,1 Bhavini H Patel,2 Jessica A Huckleberry,3 Michael D Hassman2 1Interface Analysis Associates LLC, Saratoga, CA, USA; 2scPharmaceuticals, Inc, Burlington, MA, USA; 3Heart Group of the Eastern Shore, P.C, Fairhope, AL, USACorrespondence: Michael D Hassman, scPharmaceuticals, Inc, 25 Mall Road, Suite 203, Burlington, MA, 01803, USA, Tel +1 781 301 7373, Email mhassman@scpharma.comPurpose: Furoscix® (subcutaneous furosemide) is administered using a wearable On-Body Infusor (OBI) and is approved for the treatment of congestion associated with heart failure (HF). The purpose of this study was to assess the safe and effective use of the OBI and Instructions for Use (IFU) by patients with HF, caregivers, and healthcare practitioners (HCPs).Methods: Sixty participants (patients, n=30; caregivers, n=15; HCPs, n=15) were evaluated on completion of OBI use tasks and IFU knowledge tasks in a simulated use environment. Fifteen of the patients received OBI/IFU training before evaluation.Results: Overall, 893/900 (99.2%) use tasks and 2211/2220 (99.6%) knowledge tasks were completed successfully, without differences due to training. The most common (n=6) use error was failure to wipe skin or cartridge tip with an alcohol wipe. Errors were due to forgetfulness/misinterpretation rather than IFU clarity.Conclusion: The subcutaneous furosemide OBI can be safely and effectively used by patients, caregivers, and HCPs, regardless of training.Keywords: heart failure, furosemide, subcutaneous furosemide, on-body infusor, human factors

Tuuli Turja,1 Milla Rosenlund,2 Hanna Kuusisto2– 4 1Faculty of Social Sciences, Tampere University, Tampere, Finland; 2Faculty of Social Sciences and Business Studies, Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland; 3Department of Neurology, Tampere University Hospital, Tampere, Finland; 4Faculty of Medicine, Tampere University, Tampere, FinlandCorrespondence: Tuuli Turja, Email tuuli.turja@tuni.fiObjective: In this short report contributing to the literature on treatment and vaccination adherence, nonadherence was examined from the perspective of decision-making (DM) practice in healthcare. The objective of this study was to survey the rationalities given for treatment nonadherence and their association with DM practice.Methods: The Ottawa decision Support Framework was used as a theoretical background for the study. Multiple choice and open-text responses indicating nonadherence were drawn from vignette survey data. The results have been analyzed and reported as descriptive statistics and findings of data-driven content analysis. The number of observatory units was 1032 in the within-subject study design.Results: DM practice was predominantly associated with nonadherence to vaccination, whereas nonadherence to treatment was consistently associated with attitudinal reasons independent of DM practice. Nonadherence to vaccination was most often rationalized by prior negative experiences in simple DM scenarios. After other DM practices, nonadherence was rationalized by uncertainty and criticism about the benefits of the recommended vaccine. Mistrust toward healthcare providers stood out, first in treatment nonadherence generally and, second, in vaccination nonadherence after simple DM where the final decision was left to the patient.Conclusion: In medical DM, adherence to treatment and vaccination may be achieved through a recognition of patients’ previous healthcare encounters and potential trust-related concerns, which

Sierra Pellizzari,1 Harjot Athwal,1 Anne Claudine Bonvissuto,1,2 Armen Parsyan1– 4 1Department of Anatomy and Cell Biology, Western University, London, ON, Canada; 2Verspeeten Family Cancer Centre, London Health Sciences Centre, London, ON, Canada; 3Department of Oncology, Western University, London, ON, Canada; 4Department of Surgery, St Joseph’s Health Care and London Health Sciences Centre, Western University, London, ON, CanadaCorrespondence: Armen Parsyan, Department of Surgery, St Joseph’s Health Care London, Room D1-104, 268 Grosvenor Street, London, ON, N6A 4V2, Canada, Tel +1-519-646-4831, Email aparsyan@uwo.caAbstract: Breast cancer is a leading cause of cancer-related deaths in females. Triple-negative breast cancer (TNBC) subtype is the most aggressive form of breast cancer that lacks biomarkers and effective targeted therapies. Its high degree of heterogeneity as well as innate and acquired resistance to treatment creates further barriers in achieving positive clinical outcomes in TNBC. Thus, development of novel treatment approaches in TNBC is of high clinical significance. Multimodality approaches with targeted agents and radiotherapy (RT) are promising for increasing efficacy of treatment and circumventing resistance. Here we examined anticancer effects of the Aurora Kinase B (AURKB) inhibitor AZD1152 as a single agent and in combination with RT using various TNBC cell lines, MDA-MB-468, MDA-MB-231 and SUM-159. We observed that AZD1152 alone effectively inhibited colony formation in TNBC cell lines. The combination of AZD1152 at IC50 concentrations together with ionizing radiation further reduced colony formation as compared to the single agent treatment. Our data support the notion that inhibition of the AURKB pathway is a promising strategy for treatment and radiosensitization of TNBC and warrants further translational studies.Plain Language Summary: Breast cancer is a leading cause of cancer death in women globally. The triple negative breas

Wilson Takashi Hida,1,2 Cesar Vilar,1,3 Bernardo Kaplan Moscovici,4,5 Antonio Francisco Pimenta Motta,3 Pedro Carlos Carricondo2 1Department of Ophthalmology, Hospital Oftalmológico de Brasília HOB, Brasilia, DF, Brazil; 2Department of Ophthalmology, University of Sao Paulo(USP), Rio de Janeiro, RJ, Brazil; 3Department of Ophthalmology, Renato Ambrosio Research Center CEORA, Rio de Janeiro, RJ, Brazil; 4Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil; 5Department of Ophthalmology, Hospital Visão Laser, Santos, SP, BrazilCorrespondence: Wilson Takashi Hida, S GAS II St. de Grandes Áreas Sul 607 - Asa Sul, Brasília, DF, 70200-670, Brazil, Tel + 55 61 3686-4586, Email Takashi.doc@gmail.comPurpose: To validate a new methodology to evaluate the impact of astigmatism in pseudophakia using an astigmatic defocus curve.Setting: Hospital Oftalmológico de Brasilia, Brazil.Design: Non-randomized cohort study.Methods: For every point of the defocus curve, from − 2.00 to +3.00 with 0.50D intervals, visual acuity was assessed with optically induced astigmatism (0.50D, 1.00D and 1.50D at 90 and 180 degrees) in pseudophakic patients implanted with a refractive-enhanced intraocular lens.Results: Twelve patients were analyzed. A statistically significant difference was found between the 90° (ATR) and 180°(WTR) axis with 1.50D astigmatism, providing better visual acuity in ATR astigmatism (p < 0.05).Conclusion: This new methodology is reproducible, useful and may predict residual astigmatism tolerance in pseudophakic patients, which may help with surgery planning and IOL decision-making.Keywords: cataract, surgery, phacoemulsification, optics, residual astigmatism, visual performance

Achim Fieß,1,&ast; Sandra Gißler,1,&ast; Philipp S Wild,2– 4 Karl J Lackner,5 Thomas Münzel,6 Matthias Michal,7 Michael S Urschitz,8 Norbert Pfeiffer,1 Alexander K Schuster1 1Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; 2Preventive Cardiology and Preventive Medicine - Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; 3Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; 4German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany; 5Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; 6Center for Cardiology – Cardiology I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; 7Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; 8Division of Pediatric Epidemiology, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany&ast;These authors contributed equally to this workCorrespondence: Achim Fieß, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany, Tel +49-6131-17-5150, Fax +49-6131-17-8495, Email Achim.fiess@gmail.comAbstract: This study investigates the association between self-reported birth weight (BW) and the prevalence of hypertensive retinopathy (HR) in a large population-based cohort in Germany, as part of the Gutenberg Health Study (GHS). The study involved analyzing fundus photographs of 6855 participants, aged 35 to 74, to assess signs of HR, classified according to the Mitchell-Wong Classification. The research aimed

Sugi Panneerselvam, Nina Diklich, Jonathan Tijerina, Michelle M Falcone, Kara M Cavuoto Department of Ophthalmology, Bascom Palmer Eye Institute/University of Miami Miller School of Medicine, Miami, FL, USACorrespondence: Kara M Cavuoto, Department of Ophthalmology, Bascom Palmer Eye Institute/University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL, 33136, USA, Tel +1-305-326-6324, Fax +1-305-547-3675, Email kcavuoto@med.miami.eduPurpose: To explore public interest in myopia progression and management and to correlate these trends to available treatments.Methods: Keywords were chosen for interest in myopia overall and those signifying interest in myopia treatments. Treatment options were separated into four main categories: atropine, glasses, contact lenses, and orthokeratology. Search terms were queried across ten years of Google Trends data and the relative search volume was analyzed to quantify the change in search volume over time.Results: A positive linear trend over time was present for all myopia interest keywords except “nearsighted” (p = 0.074) and “near work myopia” (p = 0.086). Interest in the four myopia treatment categories included in this study also displayed a significant positive trend over time. There is also a statistically significant positive correlation between all four treatment options and four of the seven categories of population interest, “myopia control”, “myopia”, “myopia progression”, and “screen time myopia”.Conclusion: This study demonstrates the utility of GT to correlate public interest in myopia treatments over time. All treatment terms had statistically significant linear search volume growth over a ten-year period. The positive correlation between interest in myopia as a health problem and available treatments supports existing evidence that GT can track rising public health concerns and corresponding treatment-seeking behaviors.Keywords: myopia, Google Trends, nearsighted, orthokerato

Marc Fortin,1 Del R Dorscheid,2 Moishe Liberman,3 Simon Martel,1 Tawimas Shaipanich2 1Department of Pulmonary Medicine and Thoracic Surgery, University of Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Quebec City, Quebec, Canada; 2Department of Medicine, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada; 3Division of Thoracic Surgery, Centre hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, CanadaCorrespondence: Marc Fortin, Department of Pulmonary Medicine and Thoracic Surgery, Quebec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Quebec City, QC, G1V 4G5, Canada, Tel +1 418-656-8711, Email marc.fortin@criucpq.ulaval.caPurpose: Chronic bronchitis (CB), a chronic obstructive pulmonary disease (COPD) phenotype defined by persistent mucus hypersecretion and cough, is associated with poor quality of life, exacerbations, and lung function impairment. Bronchial Rheoplasty (BR) delivers non-thermal pulsed electric fields to airway epithelium and submucosa. Preliminary studies demonstrated reduced airway goblet cell hyperplasia and symptom improvement in response to BR. This study aimed to further assess the safety and clinical feasibility of BR in the setting of CB.Patients and Methods: This 3-center, single-arm study evaluated the safety and feasibility of BR in Canadian patients. The major inclusion criteria were the sum of CAT first 2 questions (cough and mucus) ≥ 7 out of 10 and FEV1 ≥ 30% predicted. Right-sided airways were treated first; left, 1 month later. Serious adverse events (SAEs) were tabulated through 12 months. Outcomes were evaluated using the SGRQ and CAT.Results: Ten patients with CB were enrolled and followed for 12 months. The BR procedure was successful in all patients (mean age 69 ± 5.8 years, post-BD FEV1 77.1 ± 28.3, SGRQ 56.2 ± 8.8, CAT 25.4 ± 4.7). Only one SAE, a COPD exacerbation 13 days following the BR procedure, was

Gordon M Riha,1 Alyssa Johnson,2 Sadie Arnold,3 Michael S Englehart,1 Simon J Thompson4 1Trauma & General Surgery, Billings Clinic, Billings, MT, USA; 2EMS & Trauma Systems Montana, Chronic Disease Prevention and Health Promotion Bureau, Montana Department of Public Health and Human Services, Helena, MT, USA; 3Laboratory Services, Billings Clinic, Billings, MT, USA; 4Collaborative Science & Innovation, Billings Clinic, Billings, MT, USACorrespondence: Simon J Thompson, Collaborative Science & Innovation, Billings Clinic, Billings, MT, USA, Tel +1 503 267 7314, Fax +1 406 435-1586, Email sthompson11@billingsclinic.orgPurpose: The state of Montana encompasses and defines rural health care as it is known in the United States (US) today. This vast area is punctuated by pockets of health care availability with varying access to blood products for transfusion. Furthermore, timely transport is frequently challenged by weather that may limit air transportation options, resulting in multiple hours in ground transport to definitive care.Patients and Methods: The Montana State Trauma Care Committee (MT-STCC) developed the Montana Interfacility Blood Network (MT-IBN) to ensure blood availability in geographically distanced cases where patients may otherwise not survive. The index case that led to the formal development of the MT-IBN is described, followed by a second case illustrating the IBN process.Results: This process and development manuscript details the innovative efforts of MT-STCC to develop this fledgling idea unique to rural US health care. We review guidelines that have been developed to define broad aspects of the MT-IBN including the reason to share resources, proper packaging, paperwork necessary for transfer, and how to provide resources directly to the patient. Finally, we describe implementation within the state.Conclusion: The MT-IBN was developed by MT-STCC to facilitate the hand-off of lifesaving blood to patients being transported by ground

Sylk Sotto-Santiago,1 Chemen Neal,2 Darren Caudill,1 Amanda Gist,1 Susannah Eastwick,3 Megan M Palmer,4 Mark W Geraci,5 David M Aronoff1 1Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; 2Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA; 3Kelley School of Business, Indiana University, Indianapolis, IN, USA; 4Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; 5Department of Medicine, University of Pittsburgh Health Sciences, Pittsburgh, PA, USACorrespondence: Sylk Sotto-Santiago, Department of Medicine at Indiana University School of Medicine, Emerson Hall 305 545 Barnhill Dr, Indianapolis, IN, 46202, USA, Email ssotto@iu.eduPurpose: To develop healthcare professionals as clinical leaders in academic medicine and learning health system; and uncover organizational barriers, as well as pathways and practices to facilitate career growth and professional fulfillment.Methods: The Department of Medicine strategic plan efforts prompted the development of a business of medicine program informed by a needs assessment and realignment between academic departments and the healthcare system. The business of medicine leadership program launched in 2017. This descriptive case study presents its 5th year evaluation. Competencies were included from the Physician MBA program and from specific departmental needs and goals.Results: The program hosted a total of 102 clinical faculty. We had a 37% response rate of those retained at Indiana University School of Medicine. Overall, responses conveyed a positive experience in the course. Over 80% of participants felt that they gained skills in professional reflection, professional socialization, goal orientation, critical thinking, and commitment to profession. Financial literacy was overwhelmingly the skill that was reported to be the most valuable. Finance and accounting were mentioned as the most difficult

Yuichi Kasai,1 Takaya Kato,2 Tadashi Inaba,3 Sotaro Baba,3 Permsak Paholpak,1 Taweechok Wisanuyotin,1 Weerachai Kosuwon,1 Hirohito Hirata,4 Tadatsugu Morimoto4 1Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 2Graduate School of Regional Innovation Studies, Tsu, Japan; 3Department of Mechanical Engineering, Graduate School of Engineering, Mie University, Tsu, Japan; 4Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, JapanCorrespondence: Yuichi Kasai, Email ykasai55@gmail.comIntroduction: Although kissing spine syndrome in the lumbar spinal region is a relatively common condition in older adults, no study examining its biomechanical characteristics has been reported. We hypothesized that kissing of the spinous processes during extension causes an increase in the flexural rigidity of the spine and significantly limits the deformation behavior of extension, which in turn might cause lower back pain.Methods: Three test models (human cadavers A, B, and C) were prepared by removing supraspinal/interspinous ligaments between L4 and L5. The dental resin was attached to the cephalocaudal spinous process so that the spinous processes between L4 and L5 were almost in contact with each other to simulate the condition of a kissing spine. The flexion-extension direction’s torque–range-of-motion (torque–ROM) curve was generated with a six-axis material tester for biomechanical measurements.Results: In all three models, the maximum ROMs at the time of extension were smaller than those at the time of flexion, and no sudden increase in torque was observed during extension.Conclusion: The results indicated no apparent biomechanical effects of kissing between the spinous processes, suggesting that the contact between the spinous processes has little involvement in the onset of lower back pain.Keywords: kissing spine syndrome, Baastrup’s disease, biomechanical study, low back pain, lumbar spine

Silvia Ottaviani,1,2 Eleonora Rondanina,1,2 Floriana Arnone,3 Virna Brucato,3 Roberto Campigli,3 Massimo Della Bona,3 Luca Tagliafico,1,2 Ennio Ottaviani,4 Alessio Nencioni,1,2 Fiammetta Monacelli1,2 1Section of Geriatrics, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, 16132, Italy; 2IRCCS Ospedale Policlinico San Martino, Genoa, Italy; 3ASL5 Ospedale San Bartolomeo, Sarzana, Italy; 4Department of Mathematics (DIMA), University of Genoa, Genoa, 16132, ItalyCorrespondence: Fiammetta Monacelli, Dipartimento di Medicina Interna e Specialità Mediche (D.I.M.I.) - Università degli Studi di Genova, Viale Benedetto XV, 6, Genova, GE, 16132, Italy, Tel/Fax +39-010-353-7545, Email fiammetta.monacelli@unige.itPurpose: In recent times, growing uncertainty has emerged regarding the effectiveness of standard pressure ulcer (PU) risk assessment tools, which are suspected to be no better than clinical judgment, especially in the frail and comorbid elderly population. This study aimed to identify the primary clinical predictive variables for PU development and severity in hospitalized older adults, utilizing a multidimensional frailty assessment, and compare them with the Braden scale.Patients and methods: The population consisted of 316 patients, admitted to the Geriatric Unit and Transitional Care of San Bartolomeo Hospital in Sarzana (Italy) during the period 21/02/22-01/07/22. The collected information included both anamnestic and laboratory data. A comprehensive geriatric assessment was performed, including also anthropometric and physical performance measurements. Multivariate logistic analysis was used, both in a binary classification test and in the subsequent ordinal classification test of severity levels. The final performance of the model was assessed by ROC curve estimation and AUC comparison with the Braden scale.Results: Within the population, 152 subjects (48%) developed PU at different levels of severity. The results sh

Christopher M Lam,1 Sarah A Keim,2 Dawood Sayed,1 Alaa Abd-Elsayed,3 Amitabh Gulati,4 Michael E Schatman,5,6 Timothy Deer,7 Usman Latif1 1Department of Anesthesiology, Pain and Perioperative Medicine, University of Kansas Medical Center, Kansas City, KS, USA; 2Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA; 3Department of Anesthesiology and Perioperative Medicine, University of Wisconsin, Madison, WI, USA; 4Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY, USA; 5Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 6Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA; 7The Spine and Nerve Center of the Virginias, Charleston, WV, USACorrespondence: Christopher M Lam, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1034, Kansas City, KS, 66160, USA, Tel +1-(704)-488-5665, Fax +1-913-588-3365, Email clam2@kumc.eduBackground: Chronic abdominal pain (CAP) is a common and challenging to treat condition with a global prevalence of up to 25%. Despite extensive evaluation, approximately 40% of patients with CAP have an unknown diagnosis. Medications may be ineffective, and surgery is rarely indicated. Interventional treatment including sympathetic blocks, sympathetic neurolysis, and transversus abdominal plane (TAP) blocks may be an option, but their efficacy can wane over time. Neuromodulation has emerged as an option for these patients, as there is evidence of success with dorsal column spinal cord and dorsal root ganglion (DRG) stimulation. Peripheral nerve stimulation (PNS) may be an alternative option, particularly in higher risk patients or in patients for whom neuraxial access may be unsafe or too technically challenging. Thoracoabdominal nerve peripheral nerve stimulation via a TAP approach may be more specifically targeted in compa

Holly A Maulhardt,1 Alyson M Marin,1 Gere S diZerega1,2 1US Biotest, Inc, San Luis Obispo, CA, USA; 2Nanology, LLC, Fort Worth, TX, USACorrespondence: Gere S diZerega, US Biotest, Inc, 231 Bonetti Drive, Suite 240, San Luis Obispo, CA, 93401, USA, Tel +01 805 595 1300, Email Gere.diZerega@usbiotest.comAbstract: The effects of intratumoral (IT) large surface area microparticle paclitaxel (LSAM-PTX) alone and in combination with systemic administration of the programmed cell death protein antibody (anti-mPD-1) were evaluated in a syngeneic murine model of melanoma. Groups of mice with subcutaneously implanted Clone M3 (Cloudman S91) tumors were treated with single and combination therapies. Tumor volume (TV) measurements, body weights, and clinical observations were followed in-life. At end of study, tumor-site tissues were collected, measured, and processed for flow cytometry along with blood and lymph nodes. The combination of LSAM-PTX + anti-mPD-1 resulted in an antitumoral response, which produced a significant decrease in TV compared to control animals. TV decreases also occurred in the LSAM-PTX and anti-mPD-1 groups. Flow cytometry analysis found increases in granulocytes and M2 macrophages and decreases in dendritic cells (DC) and monocytic myeloid-derived suppressor cells (M-MDSC) in tumor-site tissues. Increases in granulocytes and decreases in CD4+ T cells, macrophages, and M1 macrophages were found in the blood of animals administered the combination treatment. Increases in natural killer (NK) cells were found in lymph node tissue in the combination treatment group. These findings suggest that IT LSAM-PTX may provide benefit in the local treatment of melanomas and may synergize with systemic anti-PD-1 therapy, leading to additional tumoricidal outcomes without added systemic toxicity.Keywords: clone M-3, nanopac, combinatorial immunotherapy, PD-1

Mark Gurnell,1,2 Amr Radwan,3 Claus Bachert,4– 6 Njira Lugogo,7 Seong H Cho,8 Scott Nash,9 Haixin Zhang,9 Asif H Khan,10 Juby A Jacob-Nara,11 Paul J Rowe,11 Yamo Deniz9 1Department of Medicine, Wellcome–MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK; 2NIHR Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Cambridge, UK; 3Global Medical Affairs, Regeneron Pharmaceuticals Inc., Uxbridge, UK; 4Department of Otorhinolaryngology – Head and Neck Surgery, University Hospital of Münster, Münster, Germany; 5International Airway Research Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China; 6Division of ENT Diseases, CLINTEC, Karolinska Hospital, Stockholm University, Stockholm, Sweden; 7Division of Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA; 8Division of Allergy-Immunology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA; 9Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA; 10Global Medical Affairs, Sanofi, Chilly-Mazarin, France; 11Global Medical Affairs, Sanofi, Bridgewater, NJ, USACorrespondence: Mark Gurnell, Metabolic Research Laboratories, Wellcome–MRC Institute of Metabolic Science, Level 4, Box 289, Addenbrooke’s Hospital, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK, Tel +44 1223 336792, Email mg299@medschl.cam.ac.ukPurpose: Dupilumab significantly reduced the requirement for systemic corticosteroids (SCS) in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP). Patients with CRSwNP and coexisting asthma typically have a higher disease burden and have more difficulty in managing disease. Here, we report an analysis of asthma outcomes and SCS use in patients with CRSwNP and coexisting asthma.Patients and Methods: This was a post hoc analysis of the randomized, placebo-controlled SINUS-24 and SINUS-52 studies (NCT02912468/NCT02898454) in patients with severe CR

Qiankun Zhang,1,2 Zhuoqin Ren,3– 5 Jie Li,1,2 Zhengping Zou3– 5 1Department of Nephrology, the Fifth Affiliated Hospital of Wenzhou University, Lishui, Zheiang, People’s Republic of China; 2Department of Nephrology, Lishui Central Hospital, Lishui, Zhejiang, People’s Republic of China; 3Department of Nephrology and Rheumatology, Qianjiang Central Hospital, Qianjiang, Hubei, People’s Republic of China; 4Department of Nephrology and Rheumatology, Qianjiang Hospital Affiliated to Renmin Hospital of Wuhan University, Qianjiang, Hubei, People’s Republic of China; 5Department of Nephrology and Rheumatology, Qianjiang Clinical College of Yangtze University, Qianjiang, Hubei, People’s Republic of ChinaCorrespondence: Zhengping Zou, Email zouzhengping@foxmail.comObjective: This research aimed to explore the correlation between antiphospholipid antibodies (aPLs) and complement activation in lupus nephritis (LN) patients.Methods: A retrospective analysis was carried out on patients diagnosed with LN based on renal biopsy from June 2019 to June 2022. The study assessed levels of IgM, IgA, and IgG subtypes of anticardiolipin antibodies (aCLs) and anti-β 2-glycoprotein I (anti-β 2-GPI) antibodies. Pathological and clinical data were collected concurrently with the renal biopsy.Results: The analysis included 76 LN patients, with 44.7% testing positive for aPLs. LN patients with positive aPLs exhibited increased hematuria, higher SLEDAI scores, reduced serum C3 and C4 levels, and more C1q deposits in the glomerulus compared to those with negative aPLs (P< 0.05). Correlation analysis demonstrated the inverse relationships between IgG-aCL levels and serum C3 and C4 levels (r=− 0.29, P=0.005; r=− 0.24, P=0.016, respectively), as well as a positive correlation with C4 deposits in the glomerulus (r=0.20, P=0.041).Conclusion: This investigation suggests that aPLs, particularly IgG-aCLs, may be associated with the severity of LN and could contribute to the activatio

Haonan Wang,1,2 Yinghong Dai,3 Xiaotian Li,2,4 Liang Yu1 1Department of Exercise Physiology, School of Sport Science, Beijing Sport University, Beijing, 100084, People’s Republic of China; 2Department of Physical Education and Research, Central South University, Changsha, 410083, People’s Republic of China; 3Xiangya School of Medicine, Central South University, Changsha, 410008, People’s Republic of China; 4School of Sport Training, Wuhan Sports University, Wuhan, Hubei, 430079, People’s Republic of ChinaCorrespondence: Xiaotian Li, Department of Physical Education and Research, Central South University, Changsha, 410083, People’s Republic of China, Tel +86 18975197870, Fax +86 731 88876141, Email xiaotianli@csu.edu.cn Liang Yu, Department of Exercise Physiology, School of Sport Science, Beijing Sport University, Beijing, 100084, People’s Republic of China, Tel/Fax +86 1062967640, Email yuliang@bsu.edu.cnIntroduction: Poor sleep negatively impacts cognitive and physical functioning and affects athletic and academic achievement. “Dual-career” athletes emphasize the pursuit of academic excellence along with athletic performance.Purpose: The study aimed to assess sleep characteristics and sleep quality in dual-career collegiate badminton athletes. Furthermore, the study explored associations between training and academic stress and sleep, providing a theoretical basis for better training and sleep programs for dual-career athletes.Participants and Methods: In this study, 15 dual-career collegiate badminton athletes were recruited, and 12 subjects (male n = 8, female n = 4, mean age 20.3 ± 1.7) completed the questionnaire. Repeated measurements were taken monthly in the spring semester from March to August 2021. The questionnaire assessed sleep quality and daytime sleepiness by the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Score (ESS). Moreover, we collected average training, study time per week, and monthly sports competitions and ac

John C Grable,1,&ast; Kevin Shan,1,&ast; Matthew Wang,1,&ast; Daniel D Han,1,&ast; Kristen Sportiello,1,&ast; Melissa Chang,1,&ast; Justin R Sysol,1,&ast; Doris Bugbee,2,&ast; Kenneth Peltzer1,&ast; 1Department of Medicine, University of Rochester School of Medicine, Rochester, NY, USA; 2Department of Nursing, University of Rochester School of Medicine, Rochester, NY, USA&ast;These authors contributed equally to this workCorrespondence: John C Grable, University of Rochester School of Medicine, 601 Elmwood Avenue, Rochester, NY, 14642, USA, Tel +1 585-275-7424, Fax +1 585-276-2820, Email john_grable@urmc.rochester.eduPurpose: Providing effective tobacco dependence treatments to hospitalized patients remains a challenge. Prior to 2021, the Rochester Model program used staff nurses for both bedside and post-discharge counseling necessary to maintain abstinence. When nurse shortages and elevated job stress occurred during the COVID Pandemic, we proposed that medical students learn to counsel patients at the bedside and after discharge.Patients and Methods: Due to COVID restrictions, first- and second-year medical students trained using remote Zoom sessions. The total training time was 2.5 hr without role-play or additional evaluations. A survey measured the students’ satisfaction, confidence, and counseling barriers. A smoking patient on a participating hospital unit can enroll in the program. Students delivered bedside counseling, then provided follow-up treatment and outcome calls along with New York State Quitline counselors.Results: The survey demonstrated that 89% of the students were satisfied with the training. The bedside counseling confidence was greater than the phone counseling confidence. All students felt the program experience has value to them as future physicians. 124 smoking patients enrolled, and outcomes followed out to 6 months. The 7-day point prevalence quit rates using the as-treated (patients contacted)

Anne Lise Meulenbroek,1 Ewout W Steyerberg,2 Ties L Janssen,1 Stefanie R van Mil,1 Miriam C Faes,3 Lijckle van der Laan1,4 1Department of Surgery, Amphia Hospital, Breda, the Netherlands; 2Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; 3Department of Geriatrics, Amphia Hospital, Breda, the Netherlands; 4Department of Cardiovascular Sciences, Research Group of Vascular Surgery, KU Leuven, Leuven, BelgiumCorrespondence: Anne Lise Meulenbroek, Department of Surgery, Amphia Hospital, Molengracht 21, Breda, 4818 CK, the Netherlands, Tel +31 76 595 3157, Fax +31 76 595 3818, Email AMeulenbroek1@amphia.nlObjective: Delirium is a common and serious postoperative complication in elderly patients undergoing abdominal aortic aneurysm (AAA) repair and is associated with a variety of adverse outcomes. Multimodal prehabilitation aims to identify and minimize potential risk factors for delirium and improve overall health. The aim of this study is to investigate the effect of multimodal prehabilitation on delirium incidence in elderly patients undergoing elective repair for AAA.Methods: A single-centre cohort analysis was performed in the Netherlands for patients aged ≥ 70 years, undergoing elective repair for AAA (open surgery and endovascular aortic repair). Prehabilitation was gradually introduced between 2016 and 2019 and offered as standard care from 2019. The program was constructed to optimize overall health and included delirium risk assessment, home-based tailor-made exercises by a physical therapist, nutritional optimization by a dietician, iron infusion in case of anaemia and a comprehensive geriatric assessment by a geriatrician in case of frailty. The primary outcome was incidence of delirium within 30 days after surgery.Results: A total of 81 control and 123 prehabilitation patients were included. A reduction in incidence of delirium was found (11.1% in the control group to 4.9% in the prehabilitation group), with

Ling-Ling Zhu,1 Yan-Hong Wang,2 Mei-Juan Lan,3 Quan Zhou2 1VIP Geriatric Ward, Division of Nursing, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of China; 2Department of Pharmacy, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of China; 3Division of Nursing, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of ChinaCorrespondence: Quan Zhou, Department of Pharmacy, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road No. 88, Hangzhou, 310009, People’s Republic of China, Email zhouquan142602@zju.edu.cn Mei-Juan Lan, Division of Nursing, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road No. 88, Hangzhou, 310009, People’s Republic of China, Email lanmj@zju.edu.cnAbstract: Medication reconciliation (MR) is the process of comparing a patient’s medication orders to all of the medications that the patient has been taking in order to identify and resolve medication discrepancies. It is an effective means of risk management to avoid medication errors (eg, omissions, duplication, dosage errors, or drug interactions). Some guidelines explicitly state that MR is a pharmacist-led transition of care; however, there is a shortage of qualified pharmacists to meet the increasing clinical needs, and clinical nurses’ roles have not been clearly described. This paper aimed to enable nurses to gain confidence in contributing to MR at discharge and to make the industry aware of the potential risks if nurses do not actively intervene in this area. A narrative approach was used to introduce experiences in identifying discrepancies and medication errors through MR at discharge in a geriatric ward of an academic medical center hospital in China. The nurses’ main roles in MR involve chasing, che

Janika Krafthöfer,1 Sophie-Charlotte Fabig,1 Ralf Baron,1 Janne Gierthmühlen1,2 1Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Schleswig-Holstein, Germany; 2Department for Anesthesiology and Surgical Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Schleswig-Holstein, GermanyCorrespondence: Janika Krafthöfer, Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus D, Kiel, 24105, Germany, Tel +49 431 500 23911, Fax +49 431 500 20914, Email janika.krafthoefer@web.deBackground: Pain leads to activation of the autonomic nervous system and thus, among other things, to pupillary reflex dilation (PRD). Previous studies have already confirmed a correlation between the perception of pain and the pupillary reaction, measured using pupillometry. However, the previous study populations were under the influence of medication for analgesia in perioperative setting or suffered from pain. This study examines the relationship between pupillary reaction and pain perception in healthy controls and addresses the question of whether endogenous pain inhibition, clinically tested by conditioned pain modulation (CPM), can be quantified using pupillometry.Methods: Forty-two healthy volunteers (21 females, 21 males, mean age 27.9 ± 5.8 years, range 20– 39 years) were included in this study. The PRD, as a measure of the pupillary reaction (variance from the base diameter in percent), was investigated during baseline, heat application and during CPM testing and results compared to the reported pain intensity on the numerical rating scale (NRS).Results: The volunteers showed higher variances under painful conditions compared to the measurement at rest corresponding to higher sympathetic activity during pain. Volunteers with a higher variance, ie a stronger pupillary

Jean Paul Brutus,1 Thiên-Trang Vo,1 Min Cheol Chang2 1Exception MD, Montreal, Canada; 2Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of KoreaCorrespondence: Min Cheol Chang, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1 Daemyungdong, Namku, Daegu, 705-717, Republic of Korea, Tel +82-53-620-4862, Email wheel633@gmail.comPurpose: Carpal tunnel syndrome (CTS) is commonly encountered in clinical practice. Diagnostic tools that currently exist include painful provocative maneuvers, invasive nerve conduction studies and the use of tests that require physician’s direct participation in an era of sanitary crisis and virtual consultations. Therefore, having an easily accessible, reliable and practical tool for diagnosing CTS would be highly beneficial. Herein, we investigated the diagnostic value of the “pronation compensation sign” that we described for diagnosing CTS.Patients and Methods: We included 18 hands with and 18 hands without CTS (age: CTS hands = 52.5 ± 13.8 years, non-CTS hands = 43.2 ± 12.3 years; sex ratio: CTS hands = 12:8, non-CTS hands = 9:9). The presence of the “pronation compensation sign” was evaluated in each included hand. The presence of the “pronation compensation sign” were compared between CTS and non-CTS hands using the chi-squared test. Statistical significance was set at p < 0.05. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated of the “pronation compensation sign” for CTS.Results: All 18 hands with CTS showed a positive “pronation compensation sign”, while those without CTS were negative. All 18 hands that were positive for the “pronation compensation sign” were hands with CTS, while those that were negative were hands without CTS. The sensitivity and specificity of the “pronation compensation sign” for diagnosing CTS were both 100%. The PP

Yoshiaki Kabata,1 Tetsutaro Oki,1 Tadashi Nakano2 1Department of Ophthalmology, Jikei University School of Medicine, Daisan Hospital, Tokyo, Japan; 2Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, JapanCorrespondence: Yoshiaki Kabata, Department of Ophthalmology, Jikei University School of Medicine, Daisan Hospital, 4-11-1 Izumihontyou, Komae-si, Tokyo, 125-8506, Japan, Tel +81334801151, Fax +81334805700, Email kabata22122@gmail.comPurpose: To evaluate the refractive prediction error in flanged intrascleral intraocular lens (IOL) fixation using the SRK/T formula and compare the axial length using a single IOL.Methods: Seventy-six eyes from 70 patients (45 males and 25 females) were included in this study. The mean age at the time of surgery was 73.4 ± 12.3 years. The patients underwent flanged IOL fixation using a PN6A (Kowa). All surgeries were performed by two surgeons (Y. K. and T. O.) between Jan 2020 and Dec 2022 at Jikei University Daisan Hospital. IOL power was calculated using the SRK/T formula with IOL Master 700 (Carl Zeiss) as the bag power. The recommended value of 119.0 was used for the A-constant. The actual refractive spherical equivalent was calculated and compared with preoperative predictions. Refractive prediction errors were defined as the deviation of the actual postoperative spherical equivalent refraction in diopters from the predicted preoperative spherical equivalent refraction. The patients were divided into three groups according to axial length: < 22.0 mm (short eyes), 22.0– 24.5 mm (medium eyes), and > 24.5 mm (long eyes), and the refractive prediction errors and mean absolute errors were compared.Results: The mean refractive prediction error was − 0.20 ± 0.52D. The mean absolute error was 0.44 ± 0.33D. The mean refractive prediction errors were not significantly different between the 22.0– 24.5 mm (medium eyes) and > 24.5 mm (long eyes) groups. (P=0.06) The mean absolute errors were not sig

Abdelrahman M Elhusseiny,1,2 Muhammad Z Chauhan,1 Ahmed B Sallam1,3 1Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, the University of Arkansas for Medical Sciences, Little Rock, AR, USA; 2Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA; 3Department of Ophthalmology, Ain Shams University, Cairo, EgyptCorrespondence: Ahmed B Sallam, Department of Ophthalmology, Jones Eye Institute, the University of Arkansas for Medical Sciences, 4301 W Markham Street &num; 523, Little Rock, AR, 72205, USA, Email ahmedsallam11@yahoo.comPurpose: Many physicians charge more than the Medicare insurance program pays. Current charge-to-payment ratios in ophthalmology and trends over the years are unknown. In this work, we examined physician charge-to-payment ratios in ophthalmology across procedures and consultations.Methods: We utilized data from 100% final-action physician/supplier Part B Medicare fee-for-service (FFS) population from 2015 to 2020. We retrieved data on ophthalmic procedures and consultations, both facility-based and non-facility-based, conducted by ≥ 50 ophthalmologists. We analyzed median charge-to-payment ratios, which were calculated as submitted charges divided by the Medicare-allowed payments, between ophthalmic procedures and consultations to assess for trends over the study period.Results: We find that the median charge-to-payment ratio for all current procedural terminology (CPT) codes in 2020 was 2.23 (Interquartile range (IQR): 1.54– 3.27) as compared to 2.00 (IQR: 1.39– 2.92) in 2015, an overall 2.76% average annual growth rate from 2015– 2020. For ophthalmic procedures, the median charge-to-payment ratio in 2020 was 3.03 (IQR: 2.13– 4.41) compared to 2.79 (IQR: 1.96– 3.97) in 2015, corresponding to a 2.01% AAGR from 2015– 2020. For consultations, those rates were 2.06 (IQR: 1.48– 2.96), 1.85 (IQR: 1.33– 2.59), and 2.71%, respectively.Conclusion: We found that the su

Silvia Schrittenlocher,1 Jithmi Weliwitage,2 Mario Matthaei,1 Björn Bachmann,1 Claus Cursiefen1,3 1Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, NRW, Germany; 2University of Cologne, Institute for Medical Statistics and Computational Biology (IMSB), Cologne, NRW, Germany; 3University of Cologne, Center for Molecular Medicine Cologne (CMMC), Cologne, NRW, GermanyCorrespondence: Silvia Schrittenlocher, Kerpener Str. 62, Cologne, 50937, Germany, Tel +49 221– 4313, Fax +49 221– 3186, Email Silvia.Schrittenlocher@uk-koeln.dePurpose: To determine which donor characteristics, like previous diseases and surgeries, influence the severity of the DM/endothelial lamella preparation prior to DMEK-surgery.Patients and Methods: Retrospective cross-sectional single-center study is presented. Eight hundred and forty-six eyes with DMEK-surgery between 01/2018 and 01/2021 performed at the University Hospital Cologne, Germany, were included. Information regarding the donors’ previous diseases and surgeries were provided by a large database of a cornea bank (Multi Tissue Bank Mecklenburg-Vorpommern) and merged with the Cologne DMEK database, which contains information regarding preparation characteristics of the surgeon-prepared graft directly preoperatively. Three preparation groups (easy, difficult and very difficult) were correlated to the donors’ previous diseases and surgeries. The following characteristics were used for the assignment in one of the three groups: stripping difficulty, rolling and staining behavior, central and peripheral adherences, tissue fragility and DM-splitting.Results: Significant risk factors for DM-splitting were diabetes mellitus (DMel) type II, heart failure, chronic kidney disease and previous cataract surgery (p=0.022, p=0.012; p=0.047 and p< 0.001 respectively). Previous DMel (especially type 2) was significantly associated with the occurrence of central adherences (p=0.009

Madalina Macrea,1 Atul Malhotra,2 Richard ZuWallack,3 Krisann Oursler,4 Richard Casaburi5 1Department of Pulmonary and Sleep Medicine, Salem Veterans Affairs Medical Center, University of Virginia, Charlottesville, VA, USA; 2Department of Pulmonary, Critical Care and Sleep Medicine, University of California at San Diego, San Diego, CA, USA; 3Department of Pulmonary, Critical Care, and Sleep Medicine St. Francis Hospital, Hartford, CT, USA; 4Department of Geriatrics and Infection Disease, Salem Veterans Affairs Medical Center, Carilion Virginia Tech School of Medicine, Roanoke, VA, USA; 5Division of Respiratory and Critical Care Physiology and Medicine, Lundquist Institute for Biomedical Innovation at Harbor-University of California at Los Angeles Medical Center, Torrance, CA, USACorrespondence: Madalina Macrea, Department of Pulmonary and Sleep Medicine, Salem Veterans Affairs Medical Center, Salem, VA, 24153, USA, Tel +1 540 982 2463 ext 6609, Email madalina.macrea@va.govAbstract: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in Overlap Syndrome (OS), the co-occurrence of Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease. Clustering of patients in subgroups with similar pre-clinical manifestations (ie, endothelial dysfunction) may identify relevant therapeutic phenotype categories for patients with OS who are at high risk of CVD. We therefore conducted a cross-sectional pilot study of endothelial function in 7 patients with OS (Forced Expiratory Volume in 1 second/Forced Vital Capacity < 0.7) on continuous positive airway pressure therapy (n = 7) to assess the relationship between FMD and physical activity. We found a strong association between FMD and step counts (rho = 0.77, p = 0.04); and FMD and moderate physical activity (rho = 0.9, p = 0.005). Further, larger studies are needed to confirm that FMD may identify patients with OS at high risk of CVD who benefit from increased physical activity.Keywords: flow-medi

Matthew K Laker,1,2 Petr Bob,1 Norbert Riethof,1 Jiri Raboch1 1Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry & UHSL, First Faculty of Medicine, Charles University, Prague, Czech Republic; 2School of Art and Sciences, LaSalle University, Philadelphia, PA, USACorrespondence: Petr Bob, Center for Neuropsychiatric Research of Traumatic Stress & Department of Psychiatry, First Faculty of Medicine of Charles University, Ke Karlovu 11, 128 00, Prague, Czech Republic, Email petrbob@netscape.netBackground: Intense fear of flying, called aviophobia, is a highly prevalent psychological phenomenon, afflicting (in some estimates) up to 40% of the population of industrialized countries and although aviophobia is a highly prevalent mental health problem, published studies about its epidemiology and treatment are rare.Methods: In this study, including 61 participants (28 males and 33 females; mean age 26.85) engaged in business related travels in the last two years, we assessed relationships of fear of flying problems with symptoms of stress also reflecting childhood traumatic stress experiences and its influences on brain sensitization and epileptic-like symptoms. In this assessment we also studied fear of flying symptoms and work related psychological problems described as burnout.Results: The results show that the participants who manifest higher levels of stress symptoms have higher levels of aviophobic experiences. Stress symptoms measured by TSC-40 manifested significant correlations with aviophobic experiences measured by Flight Anxiety Modality Questionnaire (FAS) (Spearman R=0.46, p< 0.01). Other correlations were found between FAS and Limbic System Checklist (LSCL-33) (Spearman R=0.39, p< 0.01) and FAS and Burnout Measure (BM) (Spearman R=0.30, p< 0.01).Conclusion: The results of this study indicate that the experience of fear of flying is related to past and recent stressful events and also to levels of work related p

Janice Du Mont,1,2 Frances Montemurro,1 Rhonelle Bruder,1,2 C Emma Kelly,1 Frances Recknor,1 Robin Mason1,2 1Women’s College Research Institute, Women’s College Hospital, Toronto, ON, M5S 1B2, Canada; 2Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, CanadaCorrespondence: Janice Du Mont, Women’s College Research Institute, Women’s College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, Email janice.dumont@wchospital.caAbstract: Health care providers are highly likely to encounter persons who have been domestically sex trafficked and, therefore, possess valuable insights that could be useful in understanding and improving existing services and supports. In-depth interviews were conducted with 31 health care providers residing and working in Canada’s largest province, Ontario. Results were analyzed using Braun and Clarke’s analytical framework. Across providers, a key theme was identified: “Facilitators to improve care”, which was comprised of two sub-themes, “Address needs in service provision” and “Center unique needs of survivors”. From these results, eight wide-ranging recommendations to improve services and supports were developed (eg, Jointly mobilize an intersectoral, collaborative, and coordinated approach to sex trafficking service provision; Employ a survivor-driven approach to designing and delivering sex trafficking services). These recommendations hold the potential to enhance services in Canada and beyond by reducing barriers to access and care, facilitating disclosure, aiding in recovery, and empowering those who have been domestically sex trafficked.Keywords: domestic, human trafficking, health care, recommendations, sex trafficking, social services

Fatin Nur Najwa Norazman,1,2,&ast; Bariah Mohd-Ali,1,&ast; Syarifah Faiza Syed Mohd Dardin,1,&ast; Mizhanim Mohamad Shahimin,1,&ast; Norliza Mohamad Fadzil,1,&ast; Mohd Norhafizun Mohd Saman,1,&ast; Norhani Mohidin1,&ast; 1Optometry and Vision Science Program and Research Centre for Community Health (Reach), Faculty of Health Science, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; 2Centre for Optometry Studies, Faculty of Health Sciences, Universiti Teknologi MARA Cawangan Selangor, Kampus Puncak Alam, Selangor, 42300, Malaysia&ast;These authors contributed equally to this workCorrespondence: Bariah Mohd-Ali, Optometry and Vision Science Program and Centre for Community Health, Faculty of Health Science, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 50300, Malaysia, Tel +60 39 289 7602, Email bariah@ukm.edu.myAbstract: Myopia control lenses have been shown to modify visual function; however, it is arguable if these changes are short-term or long-term. We investigated the changes in accommodative behaviour and binocular vision functions of Malay myopic children who participated in a myopia control trial utilising spectacle lenses (n = 40). This article presents baseline accommodation and binocular vision measurements. The mean (± SD) age, spherical equivalent measured by cycloplegic autorefraction, and axial length (AL) for the right eyes were 10.00 ± 1.47 years, − 3.02 ± 1.20 D, and 24.42 ± 0.93 mm, respectively. All participants had good distance and near visual acuities with high-contrast charts (100%), which were significantly better than low-contrast charts (10%) (p < 0.001). The mean (± SD) accommodative lag at baseline was 1.14 ± 0.35 D, while monocular and binocular accommodative amplitudes were 15.35 ± 2.07 D and 16.82 ± 2.27 D, respectively. Malay schoolchildren in this study were more esophoric at near compared to distance, with an accommodative-convergence over accommodation

Theresa W Guilbert,1 Kevin R Murphy,2 Eckard Hamelmann,3 Kristie R Ross,4 Atul Gupta,5 Alessandro Fiocchi,6 Changming Xia,7 Rebecca Gall,7 Olivier Ledanois,8 Amr Radwan,7 Juby A Jacob-Nara,9 Paul J Rowe,9 Yamo Deniz7 1Cincinnati Children’s Hospital and University of Cincinnati, Cincinnati, OH, USA; 2Boys Town National Research Hospital, Omaha, NE, USA; 3Department of Pediatrics, Children’s Center Bethel, University of Bielefeld, Bielefeld, Germany; 4UH Rainbow Babies and Children’s Hospital, Cleveland, OH, USA; 5King’s College Hospital, London, UK; 6Bambino Gesù Children’s Hospital IRCCS, Rome, Italy; 7Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA; 8Sanofi, Paris, France; 9Sanofi, Bridgewater, NJ, USACorrespondence: Theresa W Guilbert, Cincinnati Children’s Hospital and University of Cincinnati, Cincinnati, OH, USA, Tel +1 513-636-6771, Email theresa.guilbert@cchmc.orgBackground: Severe, uncontrolled asthma and asthma exacerbations in children are associated with abnormal lung function and airway development, and increased risk of chronic obstructive lung disease in adulthood. The rationale for this post hoc analysis was to explore the relationship between changes in asthma exacerbation rates and lung function in children treated with dupilumab.Methods: This post hoc analysis included children aged 6 to 11 years with uncontrolled, moderate-to-severe type 2 asthma (blood eosinophils ≥ 150 cells/μL or fractional exhaled nitric oxide ≥ 20 ppb) who received dupilumab or placebo in the phase 3 LIBERTY ASTHMA VOYAGE study (NCT02948959). Endpoints were the proportion of patients achieving clinically meaningful improvements (≥ 5% or ≥ 10%) in pre-bronchodilator percent-predicted forced expiratory volume in 1 second (ppFEV1) by Week 12, annualized severe asthma exacerbation rates from Week 12– 52, and mean change from baseline in ppFEV1 to Week 12.Results: At Week 12 of VOYAGE, 141/236 (60%) of children treated with dupilumab and 57/114 (50%) of

Gerald Pierone Jr,1 Laurence Brunet,2 Jennifer S Fusco,2 Cassidy E Henegar,3 Supriya Sarkar,3 Jean Van Wyk,4 Vani Vannappagari,3 Michael B Wohlfeiler,5 Gregory P Fusco2 1Department of Adult Primary Care, Whole Family Health Center, Vero Beach, FL, USA; 2Department of Epidemiology, Epividian, Raleigh, NC, USA; 3Epidemiology and Real World Evidence, ViiV Healthcare, Research Triangle Park, NC, USA; 4Global Medical, ViiV Healthcare, Brentford, UK; 5Department of Medicine, AIDS Healthcare Foundation, Miami, FL, USACorrespondence: Laurence Brunet, Epividian, 150 Fayetteville Street, Suite 2300, Raleigh, NC, 27601, USA, Tel +1-919-827-0010, Email laurence.brunet@epividian.comPurpose: Two-drug regimens (2DR) may address drug–drug interactions and toxicity concerns. Dolutegravir/lamivudine (DTG/3TC) 2DR was approved in the US for both treatment-naïve and treatment-experienced individuals with a viral load < 50 copies/mL. This study describes real-world DTG/3TC 2DR treatment outcomes among treatment-experienced individuals, stratified by age, sex, and race.Methods: From the OPERA® cohort, people with HIV with a viral load < 50 copies/mL who switched from a commonly used three-drug regimen to DTG/3TC 2DR as per the label between April 8, 2019 and April 30, 2021 were included. Incidence rates (Poisson regression) for loss of virologic control (first viral load ≥ 50 copies/mL), confirmed virologic failure (2 viral loads ≥ 200 copies/mL or discontinuation after 1 viral load ≥ 200 copies/mL), and DTG/3TC 2DR discontinuation were estimated overall and stratified by age, sex, and race.Results: The 787 individuals included were followed for a median of 13.6 months (IQR: 8.2, 22.3). Confirmed virologic failure occurred in ≤ 5 individuals. Loss of virologic control occurred at a rate of 14.0 per 100 person-years (95% CI: 11.7, 16.8). DTG/3TC 2DR discontinuation occurred at a rate of 17.5 per 100 person-years (95% CI: 15.0, 20.3); 4% discontinued for treatment-related

Risa Hirata,1 Naoko E Katsuki,1 Hitomi Shimada,2 Eiji Nakatani,3 Kiyoshi Shikino,4,5 Chihiro Saito,6 Kaori Amari,7 Yoshimasa Oda,8 Midori Tokushima,1 Masaki Tago1 1Department of General Medicine, Saga University Hospital, Saga, Japan; 2Shimada Hospital of Medical Corporation Chouseikai, Saga, Japan; 3Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan; 4Department of General Medicine, Chiba University Hospital, Chiba, Japan; 5Department of Community-Oriented Medical Education, Chiba University Graduate School of Medicine, Chiba, Japan; 6Shizuoka General Hospital, Shizuoka, Japan; 7Department of Emergency Medicine, Saga-Ken Medical Centre Koseikan, Saga, Japan; 8Department of General Medicine, Yuai-Kai Foundation and Oda Hospital, Saga, JapanCorrespondence: Masaki Tago, Department of General Medicine, Saga University Hospital, 5-1-1 Nabeshima, Saga, 849-8501, Japan, Tel +81 952 34 3238, Fax +81 952 34 2029, Email tagomas@cc.saga-u.ac.jpPurpose: There has been no large-scale investigation into the association between the use of lemborexant, suvorexant, and ramelteon and falls in a large population. This study, serving as a pilot investigation, was aimed at examining the relationship between inpatient falls and various prescribed hypnotic medications at admission.Patients and Methods: This study was a sub-analysis of a multicenter retrospective observational study conducted over a period of 3 years. The target population comprised patients aged 20 years or above admitted to eight hospitals, including chronic care, acute care, and tertiary hospitals. We extracted data on the types of hypnotic medications prescribed at admission, including lemborexant, suvorexant, ramelteon, benzodiazepines, Z-drugs, and other hypnotics; the occurrence of inpatient falls during the hospital stay; and patients’ background information. To determine the outcome of inpatient falls, items with low collinearity were selected and included as covari

Paul J Hershberger,1 Stacy R Flowers,1 Sharlo L Bayless,2 Katharine Conway,1 Timothy N Crawford1,3 1Department of Family Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA; 2Wright State University Boonshoft School of Medicine, Dayton, OH, USA; 3Department of Population and Public Health Sciences, Wright State University Boonshoft School of Medicine, Dayton, OH, USACorrespondence: Paul J Hershberger, Department of Family Medicine, Wright State University Boonshoft School of Medicine, 725 University Blvd, Dayton, OH, 45435, USA, Tel +1 937-245-7223, Fax +1 937-245-7931, Email paul.hershberger@wright.eduBackground: The contemporary challenges of improving patient engagement in chronic disease management and addressing the growing problem of physician burnout are commonly viewed as separate issues. However, there is extensive evidence that person-centered approaches to patient engagement, such as motivational interviewing (MI), are associated both with better outcomes for patients and improved well-being for clinicians.Methods: We conducted an exploratory survey study to ascertain whether resident physicians who perceive that they embrace and utilize the MI approach also report less burnout. A total of 318 residents in several specialties were invited via email to complete a 10-question survey about patient engagement and the experience of burnout. Frequencies and percentages were calculated for all categorical/ordinal variables to describe survey participants and question responses. Correlation coefficients were obtained to assess relationships between all burnout and engagement questions.Results: A total of 79 residents completed the survey (response rate of 24.8%). There was broad agreement about the importance of patient engagement and the use of the MI approach, and approximately 60% of residents indicated that burnout was a problem. Two items related to residents’ perceived use of MI were correlated with feeling a sense of personal

Lihua Zhu,1,&ast; Lingling Zhou,2,3,&ast; Liang Wang,4,&ast; Cunte Chen,2 Jie Qiao,1 Xinran Huang,1 Xiaoyan Su,1 Shaohua Chen,2 Bo Li,2 Xiuli Wu,2 Yangqiu Li2 1Department of Rheumatology and Immunology, First Affiliated Hospital, Jinan University, Guangzhou, 510632, People’s Republic of China; 2Institute of Hematology, School of Medicine, Key Laboratory for Regenerative Medicine of Ministry of Education, Jinan University, Guangzhou, 510632, People’s Republic of China; 3Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, 510632, People’s Republic of China; 4Department of Oncology, First Affiliated Hospital, Jinan University, Guangzhou, 510632, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yangqiu Li, Institute of Hematology, School of Medicine, Key Laboratory for Regenerative Medicine of Ministry of Education, Jinan University, Guangzhou, 510632, People’s Republic of China, Tel +86 20 85226877, Fax +86 20 85226877, Email yangqiuli@hotmail.com Lihua Zhu, Department of Rheumatology and Immunology, First Affiliated Hospital, Jinan University, Guangzhou, 510632, People’s Republic of China, Email zhulihua20121113@163.comBackground: There have been several studies regarding the susceptibility of A20 gene SNPs (rs2230926 and rs5029937) in rheumatoid arthritis (RA). However, little is known about the association between polymorphisms in the A20 promoter and RA. The aim of this study was to investigate the characteristics of A20 promoter polymorphisms and the association between these polymorphisms and clinical significance in Chinese RA patients.Methods: PCR and sequencing were used to identify A20 gene polymorphisms in peripheral blood mononuclear cells (PBMCs) from 123 RA cases and 31 healthy individuals.Results: Only one SNP (rs5029924) in the A20 gene promoter was identified in RA patients and healthy individuals. 6 patients who carried heterozygous rs5029924 (3918C

Tyler S Oesterle,1,&ast; Nicholas L Bormann,1,&ast; Domenic A Ochal,2 Stephan Arndt,3,4 Scott A Breitinger1 1Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA; 2Mayo Clinic Alix School of Medicine, Rochester, MN, USA; 3Department of Psychiatry, University of Iowa, Iowa City, IA, USA; 4Department of Biostatistics, University of Iowa, Iowa City, IA, USA&ast;These authors contributed equally to this workCorrespondence: Nicholas L Bormann, Department of Psychiatry and Psychology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA, Tel +1 507 284 2088, Fax +1 507 284 4158, Email bormann.nicholas@mayo.eduPurpose: Telehealth is associated with a myriad of benefits; however, little is known regarding substance use disorder (SUD) treatment outcomes when participants join group therapy sessions in a combination in-person and virtual setting (hybrid model). We sought to determine if treatment completion rates differed.Patients and Methods: Policy changes caused by the COVID-19 pandemic created a naturalistic, observational cohort study at seven intensive outpatient (IOP) programs in rural Minnesota. Virtual-only delivery occurred 6/1/2020-6/30/2021, while hybrid groups occurred 7/1/2021-7/31/2022. Data was evaluated retrospectively for participants who initiated and discharged treatment during the study period. Participants were IOP group members 18 years and older who had a SUD diagnosis that both entered and discharged treatment during the 26-month period. A consecutive sample of 1502 participants (181– 255 per site) was available, with 644 removed: 576 discharged after the study conclusion, 49 were missing either enrollment or discharge data, 14 transferred sites during treatment, and 5 initiated treatment before the study initiation. Helmert contrasts evaluated the impact of hybrid group exposure.Results: A total of 858 individuals were included. Data was not from the medical chart and was deidentified preventing specific demogra

Rajnish Nagarkar,1 Mamillapalli Gopichand,2 Suparna Kanti Pal,3 Ankur Gupta,4,5 Najmuddin Mohd Saquib,4,5 Ganga Sagar,4 Kanury VS Rao,4,5 Zaved Siddiqui,4,5 Imliwati Longkumer6 1Surgical Oncology, HCG Manavta Cancer Centre, Nashik, Maharashtra, India; 2Surgical Oncology, HealthCare Global Enterprises Limited, Vijayawada, India; 3Radiotherapy, Indoriv Clinical, Kolkata, India; 4Research and Development Section, PredOmix Technologies Private Limited, Gurugram, India; 5Research and Development Section, PredOmix Health Sciences Private Limited, Singapore; 6Biochemistry, North East Cancer Hospital and Research Institute, Guwahati, Assam, IndiaCorrespondence: Imliwati Longkumer; Zaved Siddiqui, Email ilongkumer@yahoo.co.in; zaved@predomix.comAbstract: We evaluated the potential relevance of our multi-cancer detection test, OncoVeryx-F, for ovarian cancer screening. For this, we compared its accuracy with that of CA125-based screening. We demonstrate here that, in contrast to CA125-based detection, OncoVeryx-F detected ovarian cancer with very high sensitivity and specificity. Importantly here, Stage I cancers too could be detected with an accuracy of > 98%. Furthermore, again unlike CA 125, the detection accuracy of OncoVeryx-F remained comparable in both Caucasian and South Asian/Indian women. Thus, the robustness and accuracy of OncoVeryx-F, particularly for early-stage detection, underscores its potential utility for ovarian cancer screening.Keywords: CA 125, Oncoveryx-F, OvC, NoC, LC-MS/MS

Matteo Megna,&ast; Angelo Ruggiero,&ast; Nello Tommasino, Claudio Brescia, Fabrizio Martora, Sara Cacciapuoti, Luca Potestio Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy&ast;These authors contributed equally to this workCorrespondence: Luca Potestio, Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, Napoli, 80131, Italy, Tel +39 - 081 – 7462457, Fax +39 - 081 – 7462442, Email potestioluca@gmail.comAbstract: Tildrakizumab is a humanised IgG1/k-type monoclonal antibody that targets the p19 protein subunit of IL23. Despite its effectiveness and safety have been widely reported by clinical trials and real-life experiences, data regarding its use on patients who previously failed anti-IL17 (brodalumab, ixekizumab, bimekizumab and/or secukinumab) are scant. Therefore, further studies on this topic would be beneficial for clinicians in guiding the selection of biologic shifting, considering that anti-IL23, − 12/23, and -IL17 partially share their therapeutic targets. In this context, we performed a 28-week, single-center, real-life, retrospective study, with the aim of assessing the efficacy and safety of tildrakizumab in patients who previously failed anti-IL17, also focusing the attention on psoriasis located in difficult-to-treat areas (scalp, palms or soles, fingernails, genitals). A total of 23 patients (12 male, 52.2%; mean age 52.8 ± 12.4 years) were enrolled. Of these, 11 (47.8%) failed secukinumab, 7 (30.4%) ixekizumab, 3 (13.0%) brodalumab, 1 (4.3%) both secukinumab and ixekizumab and 1 (4.3%) bimekizumab. At baseline, mean PASI and BSA were 12.8 ± 5.9 and 18.7 ± 9.6, respectively. At W16 PASI75 and PASI90 response were achieved by 15 (65.2%), and 9 (39.1%) patients, respectively, whereas 19 (82.6%) and 13 (56.6%) subjects reached these scores at W28. One (4.3%) case of primary inefficacy and 1 (4.3%) c