Background Black patients are less likely to undergo surgery for early-stage non-small cell lung cancer (NSCLC) compared with white patients, and are more likely to undergo resection at low-volume ...hospitals. However, little is known about the relationship between hospital safety-net burden and the likelihood of curative-intent surgery for black and white patients. This study analyzes whether hospital safety-net burden is associated with curative-intent surgery among adult early-stage NSCLC patients treated at facilities accredited by the American College of Surgeons Commission on Cancer. Study Design Adult patients diagnosed with invasive initial primary early-stage (TNM I–II) NSCLC during 2003-2005 were obtained from the National Cancer Data Base. Curative-intent surgery included anatomic resection, wedge resection, and segmentectomy. Hospital safety-net burden was defined as the percent of cancer patients per facility that were Medicaid-insured or uninsured. Generalized estimating equations and linear mixed models were used to control for clustering by facility. Results Of 52,853 evaluable patients, those treated at high safety-net burden facilities were significantly less likely (unadjusted p < 0.0001) to undergo curative-intent surgery than patients treated at low safety-net burden facilities. Controlling for patient and other facility characteristics, high safety-net burden remained significantly associated (p < 0.0001) with reduced likelihood of curative-intent surgery overall (odds ratio = 0.69; 95% CI, 0.62−0.77) and in black- and white-only models (odds ratio = 0.59, 95% CI, 0.48−0.73; odds ratio = 0.71; 95% CI, 0.63−0.80, respectively). Conclusions Both black and white adult patients treated for early-stage NSCLC at high safety-net burden facilities are less likely to undergo curative-intent surgery than those treated at low safety-net burden facilities. Innovative solutions are needed to ensure quality cancer care at high safety-net burden facilities.
Previously, incisionless plication (IP) for correction of congenital penile curvature (CPC) has been performed after penile degloving via a circumscribing incision.
To describe our experience with ...non-degloving incisionless penile plication (NDIP) for correction of CPC and compare these outcomes with those of men who underwent degloving incisionless penile plication (DIP).
We conducted a retrospective review of men ≤ 45 years of age who underwent incisionless penile plication for correction of CPC between 2008 and 2020 at two adult tertiary hospitals. Patients underwent either NDIP, performed through a 2-3 cm longitudinal incision along the proximal-to-mid shaft opposite the point of maximum penile curvature, or DIP via a sub-coronal circumscribing incision.
Surgical and patient-reported outcomes were compared between the non-degloving and degloving groups.
Among the 38 men (mean age, 26 years) who met the inclusion criteria, 25 underwent NDIP, including 6 patients with biplanar curvature (2 Ventral, 4 Dorsal, 6 Lateral). Thirteen patients underwent DIP, including 1 patient with biplanar curvature (1 ventral, 1 lateral). Curvature reduction was 50 ± 23 degrees for the NDIP group and 36 ± 10 degrees for the DIP group (P = .04). Five (20%) patients in the NDIP group and nine (69%) patients in the DIP group experienced a reduction in stretched penile length following plication (SPL) (P = .01). One patient in the NDIP group underwent an additional plication for recurrent curvature.
Both NDIP and DIP are safe and highly efficacious techniques for the correction of CPC.
Kusin SB, Khouri RK, Dropkin BM, et al., Plication for Correction of Congenital Penile Curvature: With or Without Degloving?. Sex Med 2021;9:100462.
γ-Aminobutyric acid A receptor γ-subunits are important for benzodiazepine (BZD) binding and modulation of the γ-aminobutyric acid-mediated Cl â current. Previously, by using γ2/α1 chimeric ...subunits, we identified two domains of the γ2-subunit, Lys-41-Trp-82 and Arg-114-Asp-161,
that are, in conjunction, necessary and sufficient for high-affinity BZD binding. In this study, we generated additional γ2/α1
chimeric subunits and γ2 point mutants to identify specific residues within the γ2 Lys-41-Trp-82 region that contribute to
BZD binding. Mutant γ2 and γ2/α1 chimeric subunits were expressed with wild-type α1 and β2 subunits in HEK 293 cells, and
the binding of several BZDs was measured. We present evidence that the γ2 region Met-57-Ile-62 is important for flunitrazepam
binding and that, in particular, γ2 Met-57 and γ2 Tyr-58 are essential determinants for conferring high-affinity binding.
Furthermore, we identify an additional residue, γ2 Ala-79, that not only is important for high-affinity binding by flunitrazepam
(a strong positive modulator) but also plays a crucial role in the binding of the imidazobenzodiazepines Ro15-1788 (a zero
modulator) and Ro15-4513 (a weak negative modulator) in the BZD binding pocket. Results from site-directed mutagenesis of
γ2 Ala-79 suggest that this residue may be part of a microdomain within the BZD binding site that is important for binding
imidazobenzodiazepines. This separation of drug-specific microdomains for competitive BZD ligands lends insight into the structural
determinants governing the divergent effects of these compounds.
Superflares may provide the dominant source of biologically relevant UV radiation to rocky habitable-zone M-dwarf planets (M-Earths), altering planetary atmospheres and conditions for surface life. ...The combined line and continuum flare emission has usually been approximated by a 9000 K blackbody. If superflares are hotter, then the UV emission may be 10 times higher than predicted from the optical. However, it is unknown for how long M-dwarf superflares reach temperatures above 9000 K. Only a handful of M-dwarf superflares have been recorded with multiwavelength high-cadence observations. We double the total number of events in the literature using simultaneous Evryscope and Transiting Exoplanet Survey Satellite observations to provide the first systematic exploration of the temperature evolution of M-dwarf superflares. We also increase the number of superflaring M dwarfs with published time-resolved blackbody evolution by ∼10×. We measure temperatures at 2 minutes cadence for 42 superflares from 27 K5-M5 dwarfs. We find superflare peak temperatures (defined as the mean of temperatures corresponding to flare FWHM) increase with flare energy and impulse. We find the amount of time flares emit at temperatures above 14,000 K depends on energy. We discover that 43% of the flares emit above 14,000 K, 23% emit above 20,000 K and 5% emit above 30,000 K. The largest and hottest flare briefly reached 42,000 K. Some do not reach 14,000 K. During superflares, we estimate M-Earths orbiting <200 Myr stars typically receive a top-of-atmosphere UV-C flux of ∼120 W m−2 and up to 103 W m−2, 100-1000 times the time-averaged X-ray and UV flux from Proxima Cen.
Thesis (Ph. D.)--Illinois State University, 1999.
Title from title page screen, viewed July 31, 2006. Dissertation Committee: Janice Neuleib (chair), Douglas Hesse, Kenneth Lindblom. Includes ...bibliographical references (leaves 202-209) and abstract. Also available in print.
Objective
To provide evidence‐based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA).
Methods
A core group led the ...development of the recommendations, starting with the treatment questions. A literature review group conducted systematic literature reviews of studies that addressed 57 specific treatment questions, based on searches conducted in OVID Medline (1946–2014), PubMed (1966–2014), and the Cochrane Library. We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. A separate voting group reviewed the evidence and voted on recommendations for each question using the GRADE framework.
Results
In patients with active AS, the strong recommendations included use of nonsteroidal antiinflammatory drugs (NSAIDs), use of tumor necrosis factor inhibitors (TNFi) when activity persists despite NSAID treatment, not to use systemic glucocorticoids, use of physical therapy, and use of hip arthroplasty for patients with advanced hip arthritis. Among the conditional recommendations was that no particular TNFi was preferred except in patients with concomitant inflammatory bowel disease or recurrent iritis, in whom TNFi monoclonal antibodies should be used. In patients with active nonradiographic axial SpA despite treatment with NSAIDs, we conditionally recommend treatment with TNFi. Other recommendations for patients with nonradiographic axial SpA were based on indirect evidence and were the same as for patients with AS.
Conclusion
These recommendations provide guidance for the management of common clinical questions in AS and nonradiographic axial SpA. Additional research on optimal medication management over time, disease monitoring, and preventive care is needed to help establish best practices in these areas.
Objective
To update evidence‐based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA).
Methods
We conducted updated ...systematic literature reviews for 20 clinical questions on pharmacologic treatment addressed in the 2015 guidelines, and for 26 new questions on pharmacologic treatment, treat‐to‐target strategy, and use of imaging. New questions addressed the use of secukinumab, ixekizumab, tofacitinib, tumor necrosis factor inhibitor (TNFi) biosimilars, and biologic tapering/discontinuation, among others. We used the Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations and required at least 70% agreement among the voting panel.
Results
Recommendations for AS and nonradiographic axial SpA are similar. TNFi are recommended over secukinumab or ixekizumab as the first biologic to be used. Secukinumab or ixekizumab is recommended over the use of a second TNFi in patients with primary nonresponse to the first TNFi. TNFi, secukinumab, and ixekizumab are favored over tofacitinib. Co‐administration of low‐dose methotrexate with TNFi is not recommended, nor is a strict treat‐to‐target strategy or discontinuation or tapering of biologics in patients with stable disease. Sulfasalazine is recommended only for persistent peripheral arthritis when TNFi are contraindicated. For patients with unclear disease activity, spine or pelvis magnetic resonance imaging could aid assessment. Routine monitoring of radiographic changes with serial spine radiographs is not recommended.
Conclusion
These recommendations provide updated guidance regarding use of new medications and imaging of the axial skeleton in the management of AS and nonradiographic axial SpA.
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