Purpose of Review
To consolidate recent literature addressing eating disorders and disordered eating behaviors among sexual and gender minority (SGM) adolescents, including but not limited to ...lesbian, gay, bisexual, transgender, and queer (LGBTQ) adolescents.
Recent Findings
Sexual and gender minority adolescents are at heightened vulnerability to eating disorders and disordered eating behaviors compared to their cisgender and heterosexual peers, potentially due to minority stress, gender norms, objectification, and the influence of the media, peers, and parents. We report findings from recent literature on the epidemiology and prevalence, assessment, mental health comorbidity, quality of life and psychosocial functioning, risk and protective factors, and treatment and interventions for eating disorders in sexual and gender minority adolescents.
Summary
Addressing eating disorders in sexual and gender minority adolescents requires an integrated approach consisting of screening, tailored treatment, and comprehensive support to address intersectional challenges. Gender-affirming and trauma-informed care approaches may be considered.
Objective
To clarify the relevance of measuring interleukin‐6 (IL‐6) and C‐reactive protein (CRP) levels in order to predict clinical response to tocilizumab (TCZ) in rheumatoid arthritis patients.
...Methods
In a pooled, post hoc analysis of 5 pivotal trials of TCZ, we examined the distributions of baseline serum concentrations of IL‐6 and CRP, stratified by randomized treatment group, and week 24 Disease Activity Score in 28 joints (DAS28) status (DAS28 <2.6 versus DAS28 ≥2.6). Relationships between early biomarker changes and later changes in DAS28 scores were evaluated using Spearman's correlations and scatterplots. Finally, percentage changes from baseline in IL‐6 and CRP levels were evaluated.
Results
Distributions of baseline IL‐6 and CRP levels were similar for patients who achieved DAS28 scores <2.6 within 6 months of TCZ initiation and those who did not. Correlations between early changes in these 2 biomarkers and change in DAS28 scores were low (rho < 0.3 for all). Mean percentage increases from baseline in IL‐6 concentrations were observed in all treatment groups (highest in the 8 mg/kg dose group); mean percentage decreases in CRP concentrations were greater at week 2 and at all visits for the 8 mg/kg dose group.
Conclusion
Baseline serum concentrations of IL‐6 and CRP may not be predictive of clinical outcomes after TCZ treatment. Data demonstrate the efficacy of TCZ in patients across a broad range of baseline serum IL‐6 and CRP concentrations. Similarly, changes in these biomarkers after TCZ dosing are expected and may or may not correspond to changes in other clinical signs and symptoms. These results complement previous reports describing the complex interactions among biomarker changes, other therapeutic mechanisms of action, and clinical outcomes.
Reactions of Ru{C=C(H)‐1,4‐C6H4C≡CH}(PPh3)2CpBF4 (1 aBF4) with hydrohalic acids, HX, results in the formation of Ru{C≡C‐1,4‐C6H4‐C(X)=CH2}(PPh3)2Cp X=Cl (2 a‐Cl), Br (2 a‐Br), arising from facile ...Markovnikov addition of halide anions to the putative quinoidal cumulene cation Ru(=C=C=C6H4=C=CH2)(PPh3)2Cp+. Similarly, M{C=C(H)‐1,4‐C6H4‐C≡CH}(LL)Cp BF4 M(LL)Cp’=Ru(PPh3)2Cp (1 aBF4); Ru(dppe)Cp* (1 bBF4); Fe(dppe)Cp (1 cBF4); Fe(dppe)Cp* (1 dBF4) react with H+/H2O to give the acyl‐functionalised phenylacetylide complexes M{C≡C‐1,4‐C6H4‐C(=O)CH3}(LL)Cp’ (3 a–d) after workup. The Markovnikov addition of the nucleophile to the remote alkyne in the cations 1 a–d+ is difficult to rationalise from the vinylidene form of the precursor and is much more satisfactorily explained from initial isomerisation to the quinoidal cumulene complexes M(=C=C=C6H4=C=CH2)(LL)Cp’+ prior to attack at the more exposed, remote quaternary carbon. Thus, whilst representative acetylide complexes Ru(C≡C‐1,4‐C6H4‐C≡CH)(PPh3)2Cp (4 a) and Ru(C≡C‐1,4‐C6H4‐C≡CH)(dppe)Cp* (4 b) reacted with the relatively small electrophiles CN+ and C7H7+ at the β‐carbon to give the expected vinylidene complexes, the bulky trityl (CPh3+) electrophile reacted with M(C≡C‐1,4‐C6H4‐C≡CH)(LL)Cp’ M(LL)Cp’=Ru(PPh3)2Cp (4 a); Ru(dppe)Cp* (4 b); Fe(dppe)Cp (4 c); Fe(dppe)Cp* (4 d) at the more exposed remote end of the carbon‐rich ligand to give the putative quinoidal cumulene complexes M{C=C=C6H4=C=C(H)CPh3}(LL)Cp’+, which were isolated as the water adducts M{C≡C‐1,4‐C6H4‐C(=O)CH2CPh3}(LL)Cp’ (6 a–d). Evincing the scope of the formation of such extended cumulenes from ethynyl‐substituted arylvinylene precursors, the rather reactive half‐sandwich (5‐ethynyl‐2‐thienyl)vinylidene complexes M{C=C(H)‐2,5‐cC4H2S‐C≡CH}(LL)Cp’BF4 (7 a–dBF4 add water readily to give M{C≡C‐2,5‐cC4H2S‐C(=O)CH3}(LL)Cp’ (8 a–d).
Reactions of 4‐ethynyl metal phenyl‐ or thienyl‐acetylide complexes with electrophiles produce reaction products consistent with the formation of quinoidal and thienyl cumulenes.
BACKGROUND:The establishment of an effective clinical and academic culture within an institution is a multifactorial process. This process is cultivated by dynamic elements such as recruitment of an ...accomplished and diverse faculty, patient geographic outreach, clinical outcomes research, and fundamental support from all levels of an institution. This study reviews the academic evolution of a single academic plastic surgery practice, and summarizes a 10-year experience of microsurgical development, clinical outcomes, and academic productivity.
METHODS:A 10-year retrospective institutional review was performed from fiscal years 2006 to 2016. Microsurgical flap type and operative volume were measured across all microsurgery faculty and participating hospitals. Microvascular compromise and flap salvage rates were noted for the six highest volume surgeons. Univariate and multivariable predictors of flap salvage were determined.
RESULTS:The 5000th flap was performed in December of 2015 within this institutional study period. Looking at the six highest volume surgeons, free flaps were examined for microvascular compromise, with an institutional mean take-back rate of 1.53 percent and flap loss rate of 0.55 percent across all participating hospitals. Overall, 74.4 percent of cases were breast flaps, and the remaining cases were extremity and head and neck flaps.
CONCLUSIONS:Focused faculty and trainee recruitment has resulted in an academically and clinically productive practice. Collaboration among faculty, staff, and residents contributes to continual learning, innovation, and quality patient care. This established framework, constructed based on experience, offers a workable and reproducible model for other academic plastic surgery institutions.
CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, IV.
Reactions of cis-RuCl2(dppm)2 with various terminal alkynes, of the type HC≡CC6H4-4-R (1 equiv.), in the presence of TlBF4 have resulted in the formation of cationic vinylidene complexes ...trans-RuCl(=C=CHC6H4-4-R)(dppm)2BF4 (1BF4). These complexes can be isolated, or treated in situ with a suitable base (Proton Sponge, 1,8-bis(dimethylamino)naphthalene) to yield the mono-alkynyl complexes trans-RuCl(C≡CC6H4-4-R)(dppm)2 (2). Through similar reactions between cis-RuCl2(dppm)2 with 2 equiv. of alkyne, TlBF4 and base, trans-bis(alkynyl) complexes, trans-Ru(C≡CC6H4-4-R)2(dppm)2 (3), can be isolated when R is an electron withdrawing substituent (R = NO2, COOMe, C≡CSiMe3), whereas reactions with alkynes bearing electron donating substituents (R = OMe and Me) form cationic η(3)-butenynyl complexes Ru(η(3)-{HC(C6H4-4-R)=CC≡CC6H4-4-R})(dppm)2(+) (4(+)). This work highlights the importance of the electronic character of the alkyne in influencing product outcome.
Background
Congenital lipomatous overgrowth, vascular malformations, epidermal nevi, and skeletal abnormalities (CLOVES) is a complex overgrowth syndrome with dramatic aesthetic and functional ...implications. The truncal masses characteristic of CLOVES syndrome are described as vascular malformations or lipomatous lesions with variable vascular components. Herein, we describe our single-institution experience with surgical excision of CLOVES-related truncal masses and discuss future directions in treatment of these complex anomalies.
Methods
A single-institution retrospective review was performed for patients diagnosed with CLOVES syndrome. Patients undergoing excision of truncal vascular malformations were included. Outcome measures included perioperative characteristics estimated blood loss (EBL), specimen size/anatomic location, blood-product requirement, as well as length-of-stay LOS, and complication profile. Mean follow-up was 23.4 months (range 4.2–44).
Results
Three consecutive patients were reviewed, accounting for 4 surgical operations. One patient underwent two operations for two distinct masses. All lesions were located on the upper back or flank with various degrees of muscular involvement. One patient required no transfusions with an uneventful 2-day hospitalization. The remaining three patients had an EBL ranging from 1500 to 6450 mL, requiring 9–13 units of packed red blood cells and 5–8 units of fresh frozen plasma during LOS (averaging 5 days). Mean weight of resected masses was 6.26 lbs (range 2.04–12 lbs) and mass dimensions ranged between 1778.9 and 15,680 cm
3
. One patient with recurrence was subsequently treated with a combination of sclerotherapy and rapamycin, leading to significant mass reduction.
Conclusions
Management of CLOVES syndrome requires a collaborative and multimodal approach. Although surgical debulking is one treatment option, non-invasive medical modalities and sclerotherapy should be considered prior to surgical resection.
Level of evidence IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors
www.springer.com/00266
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The multi-biomarker disease activity (MBDA) score measures 12 proteins involved in the pathophysiology of rheumatoid arthritis (RA) to assess disease activity (DA). Previous studies demonstrated ...correlations between MBDA and clinical DA scores with some RA therapies. In this analysis, the relationship between DA and MBDA scores and changes in MBDA component biomarkers were evaluated in tocilizumab (TCZ)-treated patients. Patients from the ACT-RAY study were included in this analysis if they had DA measures and serum collected at pre-specified time points with sufficient serum for MBDA testing at ≥1 visit. Descriptive statistics, associations between outcomes, and percentage agreement between DA categories were calculated. Seventy-eight patients were included and were similar to the ACT-RAY population. Correlations between MBDA score and DAS28-CRP were
ρ
= 0.50 at baseline and
ρ
= 0.26 at week 24. Agreement between low/moderate/high categories of MBDA score and DAS28-CRP was observed for 77.1 % of patients at baseline and 23.7 % at week 24. Mean changes from baseline to weeks 4, 12, and 24 were proportionately smaller for MBDA score than DAS28-CRP. Unlike some other MBDA biomarkers, interleukin-6 (IL-6) concentrations increased in most patients during TCZ treatment. Correlations and agreement between MBDA and DAS28-CRP or CDAI scores were lower at week 24 versus baseline. The proportionately smaller magnitude of response observed for MBDA score versus DAS28-CRP may be due to the influence of the increase in IL-6 concentrations on MBDA score. Thus, MBDA scores obtained during TCZ treatment should be interpreted cautiously and in the context of available clinical information.
Safety concerns associated with many drugs indicated for the treatment of rheumatoid arthritis (RA) can be attenuated by the early identification of toxicity through routine laboratory monitoring; ...however, a comprehensive review of the recommended monitoring guidelines for the different available RA therapies is currently unavailable. The aim of this review is to summarize the current guidelines for laboratory monitoring in patients with RA and to provide an overview of the laboratory abnormality profiles associated with each drug indicated for RA. Recommendations for the frequency of laboratory monitoring of serum lipids, liver transaminases, serum creatinine, neutrophil counts, and platelet counts in patients with RA were compiled from a literature search for published recommendations and guidelines as well as the prescribing information for each drug. Laboratory abnormality profiles for each drug were compiled from the prescribing information for each drug and a literature search including meta-analyses and primary clinical trials data.
Reaction of cis-RuCl2(dppm)2BF4 with TlBF4 and 1,4-diethynyl-benzenes results in the formation of the vinylidene cations trans-Ru(double bond, length as m-dashCdouble bond, length as ...m-dashCH-C6H2-2,5-R2-4-Ctriple bond, length as m-dashCH)Cl(dppm)2(+) (R = H, Me). Subsequent reaction with N(n)Bu4Cl results in nucleophilic attack at the coordinated organic ligand, but not at the expected metal-bound carbon atom. Instead, trans-Ru(Ctriple bond, length as m-dashC-C6H2-2,5-R2-4-CCldouble bond, length as m-dashCH2)Cl(dppm)2 was generated which, when coupled with DFT calculations, provides evidence for an intermediate quinoidal cumulene complex.
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