Nevin Manimala

J Clin Endocrinol Metab. 2023 Jul 13:dgad414. doi: 10.1210/clinem/dgad414. Online ahead of print.

ABSTRACT

CONTEXT: The inclusion of transgender people in elite sport has been a topic of debate. This narrative review examines the impact of gender affirming hormone therapy (GAHT) on physical performance, muscle strength and markers of endurance.

EVIDENCE ACQUISITION: MEDLINE and Embase were searched using terms to define the population (transgender), intervention (GAHT) and physical performance outcomes.

EVIDENCE SYNTHESIS: Existing literature is comprised of cross-sectional or small uncontrolled longitudinal studies of short duration. In non-athletic trans men starting testosterone therapy, within 1 year, muscle mass and strength increased, and by 3 years, physical performance (push-ups, sit-ups, run time) improved to the level of cisgender men.In non-athletic trans women, feminising hormone therapy increased fat mass by approximately 30% and decreased muscle mass by approximately 5% after 12 months and steadily declined beyond 3 years. Whilst absolute lean mass remains higher in trans women, relative percentage lean mass and fat mass (and muscle strength corrected for lean mass), hemoglobin and VO2 peak corrected for weight was no different to cisgender women. After 2 years of GAHT, no advantage was observed for physical performance measured by running time or in trans women. By 4 years, there was no advantage in sit-ups. Whilst push-ups performance declined in trans women, a statistical advantage remained relative to cisgender women.

CONCLUSIONS: Limited evidence suggests that physical performance of non-athletic trans people who have undergone GAHT for at least 2 years approaches that of cisgender controls. Further controlled longitudinal research is needed in trans athletes and non-athletes.

PMID:37437247 | DOI:10.1210/clinem/dgad414

Cutan Ocul Toxicol. 2023 Jul 12:1-8. doi: 10.1080/15569527.2023.2235429. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate choroidal thickness and choroidal vascular index (CVI) in healthy women using the combined oral contraceptive pill (COCp).

METHODS: This prospective study included 30 women using COCp (3 mg drospirenone/0.03 mg ethinylestradiol) for contraception for at least 1 year and 30 healthy women who did not use COCp. Intraocular pressure (IOP), axial length (AL) and body mass index (BMI) values ​​of all participants were recorded. Subfoveal choroidal thickness (SCT) and choroidal thickness at 1500 micron distance in nasal and temporal regions (NCT, TCT) were measured through optical coherence tomography (OCT) images. Luminal, stromal and total choroidal area values were evaluated by binarization method. The ratio of the luminal choroidal area to the total choroidal area was determined as the CVI value.

RESULTS: There was no statistically significant difference in IOP and AL values between the two groups at no significant difference age and BMI index (p > 0.05, for all). SCT, NCT and TCT values were no significant difference in the two groups (p> 0.05, for all). Luminal and stromal choroidal area values ​​were found to be lower in the group using COCp (p = 0.01, p = 0.02 respectively). The CVI value was 62.1 ± 3.6% in the COCp group and 65.6 ± 4.3% in the control group. There was a significant difference between the two groups in terms of CVI value (p = 0.002).

CONCLUSION: To our knowledge, this is the first study to evaluate CVI in women using COCp, and CVI was found to be lower in individuals using COCp. Therefore, CVI can be used in the follow-up of possible ocular pathologies that may develop in individuals using COCp.

PMID:37437218 | DOI:10.1080/15569527.2023.2235429

J Am Coll Health. 2023 Jul 12:1-25. doi: 10.1080/07448481.2023.2227725. Online ahead of print.

ABSTRACT

Objective: Examine the impact of the campus food environment on postsecondary students’ dietary behaviors (e.g., dietary intake) and food purchasing. Participants: Students currently attending a postsecondary institution, all ages and geographic locations included. Methods: A systematic search from January 2000-October 2022 was conducted in six databases using postsecondary education, food environment, and diet related keywords. Results: In total, 25 quantitative and 10 qualitative studies were extracted. All quantitative studies that conducted statistical analyses (n = 15) reported a statistically significant relationship between the campus food environment and dietary intake, including both positive and negative effects. All qualitative studies (n = 10) discussed students’ experience of the campus food environment influencing their diet. Conclusions: This review found moderate evidence that the campus food environment has an impact on postsecondary students’ dietary behaviors. A campus environment that has healthy foods accessible, affordable, and acceptable for postsecondary students may have a beneficial impact on students’ dietary intake.

PMID:37437204 | DOI:10.1080/07448481.2023.2227725

Neural Comput. 2023 Jul 12:1-48. doi: 10.1162/neco_a_01601. Online ahead of print.

ABSTRACT

Understanding the effect of spike-timing-dependent plasticity (STDP) is key to elucidating how neural networks change over long timescales and to design interventions aimed at modulating such networks in neurological disorders. However, progress is restricted by the significant computational cost associated with simulating neural network models with STDP and by the lack of low-dimensional description that could provide analytical insights. Phase-difference-dependent plasticity (PDDP) rules approximate STDP in phase oscillator networks, which prescribe synaptic changes based on phase differences of neuron pairs rather than differences in spike timing. Here we construct mean-field approximations for phase oscillator networks with STDP to describe part of the phase space for this very high-dimensional system. We first show that single-harmonic PDDP rules can approximate a simple form of symmetric STDP, while multiharmonic rules are required to accurately approximate causal STDP. We then derive exact expressions for the evolution of the average PDDP coupling weight in terms of network synchrony. For adaptive networks of Kuramoto oscillators that form clusters, we formulate a family of low-dimensional descriptions based on the mean-field dynamics of each cluster and average coupling weights between and within clusters. Finally, we show that such a two-cluster mean-field model can be fitted to synthetic data to provide a low-dimensional approximation of a full adaptive network with symmetric STDP. Our framework represents a step toward a low-dimensional description of adaptive networks with STDP and could, for example inform the development of new therapies aimed at maximizing the long-lasting effects of brain stimulation.

PMID:37437202 | DOI:10.1162/neco_a_01601

J Am Coll Health. 2023 Jul 12:1-6. doi: 10.1080/07448481.2023.2230303. Online ahead of print.

ABSTRACT

Objective: To examine the interaction between high school (HS) sports participation and injury history with current moderate-to-vigorous physical activity (MVPA) among young adults. Participants: Participants (N = 236) were 18-25 years old, not currently injured, and reported no physical activity limitations. Methods: Participants completed online demographic, injury history, and physical activity surveys. A two-way analysis of covariance was used to test the interaction between HS athlete status and previous injury severity on current self-reported MVPA. Results: Participants were 22.2 ± 2.1 years, primarily White (81.8%) or Asian (6.4%), and female (77.5%). After including body mass index and race as covariates, there was a statistically significant interaction between HS athlete status and previous injury history such that current MVPA was higher among former HS athletes compared to HS recreational/nonathletes when individuals reported no injuries or mild injury severity. MVPA was similar across athlete status groups when participants reported high levels of injury severity. Conclusions: Future studies should examine whether young adults who have experienced multiple and/or severe injuries as competitive HS athletes have unique physical activity barriers.

PMID:37437201 | DOI:10.1080/07448481.2023.2230303

J Am Coll Health. 2023 Jul 12:1-10. doi: 10.1080/07448481.2023.2228425. Online ahead of print.

ABSTRACT

Objective: The purpose of this study was: (a) to determine COVID-19 vaccination rates among college students, (b) to assess what proportion of college students self-report currently or previously having COVID-19, and (c) to test theory of planned behavior (TPB)-based constructs in predicting the COVID-19 booster vaccination behavioral intentions. Methods: A non-experimental, cross-sectional study design was applied. Participants: The sample consisted of 288 college students ages 18 years and older. Results: The stepwise multiple regression revealed that attitude (β = .329; p < .001) and subjective norm (β = .244; p < .001) were statistically significant predictors of intention to receive the COVID-19 booster, accounting for 86.7% (Adjusted R² = .867, F (2, 204 = 673.002, p < .001) of the variance. Conclusions: College students are at high risk for more severe complications of COVID-19 infection due to low vaccination rates. The instrument designed for this study may be used to design TPB-based interventions to increase COVID-19 vaccination and booster intentions of college students.

PMID:37437193 | DOI:10.1080/07448481.2023.2228425

Epilepsia Open. 2023 Jul 12. doi: 10.1002/epi4.12790. Online ahead of print.

ABSTRACT

OBJECTIVE: Cortical stimulation is an important component of stereo-electroencephalography (SEEG). Despite this, there is currently no standardised approach and significant heterogeneity in the literature regarding cortical stimulation practices. Via an international survey of SEEG clinicians, we sought to examine the spectrum of cortical stimulation practices to reveal areas of consensus and variability.

METHODS: A 68-item questionnaire was developed to understand cortical stimulation practices including neurostimulation parameters, interpretation of epileptogenicity, functional and cognitive assessment and subsequent surgical decisions. Multiple recruitment pathways were pursued, with the questionnaire distributed directly to 183 clinicians.

RESULTS: Responses were received from 56 clinicians across 17 countries with experience ranging from 2 to 60 years (M=10.73, SD=9.44). Neurostimulation parameters varied considerably, with maximum current ranging from 3-10mA (M=5.33, SD=2.29) for 1Hz and 2-15mA (M=6.54, SD=3.68) for 50Hz stimulation. Charge density ranged from 8-200μC/cm² , with up to 43% of responders utilising charge densities higher than recommended upper safety limits i.e.55μC/cm² . North American responders reported statistically significant higher maximum current (p<0.001) for 1Hz stimulation and lower pulse width for 1Hz and 50Hz stimulation (p=0.008, p<0.001, respectively) compared to European responders. All clinicians evaluated language, speech, and motor function during cortical stimulation; in contrast, 42% assessed visuospatial or visual function, 29% memory, and 13% executive function. Striking differences were reported in approaches to assessment, classification of positive sites and surgical decisions guided by cortical stimulation. Patterns of consistency were observed for interpretation of the localising capacity of stimulated electroclinical seizures and auras, with habitual electroclinical seizures induced by 1Hz stimulation considered the most localising.

SIGNIFICANCE: SEEG cortical stimulation practices differed vastly across clinicians internationally, highlighting the need for consensus based clinical guidelines. In particular, an internationally standardised approach to assessment, classification, and functional prognostication will provide a common clinical and research framework for optimising outcomes for people with drug-resistant epilepsy.

PMID:37437189 | DOI:10.1002/epi4.12790

Environ Sci Technol. 2023 Jul 12. doi: 10.1021/acs.est.2c09264. Online ahead of print.

ABSTRACT

Particulate matter air pollution is a leading cause of global mortality, particularly in Asia and Africa. Addressing the high and wide-ranging air pollution levels requires ambient monitoring, but many low- and middle-income countries (LMICs) remain scarcely monitored. To address these data gaps, recent studies have utilized low-cost sensors. These sensors have varied performance, and little literature exists about sensor intercomparison in Africa. By colocating 2 QuantAQ Modulair-PM, 2 PurpleAir PA-II SD, and 16 Clarity Node-S Generation II monitors with a reference-grade Teledyne monitor in Accra, Ghana, we present the first intercomparisons of different brands of low-cost sensors in Africa, demonstrating that each type of low-cost sensor PM_2.5 is strongly correlated with reference PM_2.5, but biased high for ambient mixture of sources found in Accra. When compared to a reference monitor, the QuantAQ Modulair-PM has the lowest mean absolute error at 3.04 μg/m³, followed by PurpleAir PA-II (4.54 μg/m³) and Clarity Node-S (13.68 μg/m³). We also compare the usage of 4 statistical or machine learning models (Multiple Linear Regression, Random Forest, Gaussian Mixture Regression, and XGBoost) to correct low-cost sensors data, and find that XGBoost performs the best in testing (R²: 0.97, 0.94, 0.96; mean absolute error: 0.56, 0.80, and 0.68 μg/m³ for PurpleAir PA-II, Clarity Node-S, and Modulair-PM, respectively), but tree-based models do not perform well when correcting data outside the range of the colocation training. Therefore, we used Gaussian Mixture Regression to correct data from the network of 17 Clarity Node-S monitors deployed around Accra, Ghana, from 2018 to 2021. We find that the network daily average PM_2.5 concentration in Accra is 23.4 μg/m³, which is 1.6 times the World Health Organization Daily PM_2.5 guideline of 15 μg/m³. While this level is lower than those seen in some larger African cities (such as Kinshasa, Democratic Republic of the Congo), mitigation strategies should be developed soon to prevent further impairment to air quality as Accra, and Ghana as a whole, rapidly grow.

PMID:37437161 | DOI:10.1021/acs.est.2c09264

N Engl J Med. 2023 Jul 13;389(2):118-126. doi: 10.1056/NEJMoa2213329.

ABSTRACT

BACKGROUND: Craniopharyngiomas, primary brain tumors of the pituitary-hypothalamic axis, can cause clinically significant sequelae. Treatment with the use of surgery, radiation, or both is often associated with substantial morbidity related to vision loss, neuroendocrine dysfunction, and memory loss. Genotyping has shown that more than 90% of papillary craniopharyngiomas carry BRAF V600E mutations, but data are lacking with regard to the safety and efficacy of BRAF-MEK inhibition in patients with papillary craniopharyngiomas who have not undergone previous radiation therapy.

METHODS: Eligible patients who had papillary craniopharyngiomas that tested positive for BRAF mutations, had not undergone radiation therapy previously, and had measurable disease received the BRAF-MEK inhibitor combination vemurafenib-cobimetinib in 28-day cycles. The primary end point of this single-group, phase 2 study was objective response at 4 months as determined with the use of centrally determined volumetric data.

RESULTS: Of the 16 patients in the study, 15 (94%; 95% confidence interval [CI], 70 to 100) had a durable objective partial response or better to therapy. The median reduction in the volume of the tumor was 91% (range, 68 to 99). The median follow-up was 22 months (95% CI, 19 to 30) and the median number of treatment cycles was 8. Progression-free survival was 87% (95% CI, 57 to 98) at 12 months and 58% (95% CI, 10 to 89) at 24 months. Three patients had disease progression during follow-up after therapy had been discontinued; none have died. The sole patient who did not have a response stopped treatment after 8 days owing to toxic effects. Grade 3 adverse events that were at least possibly related to treatment occurred in 12 patients, including rash in 6 patients. In 2 patients, grade 4 adverse events (hyperglycemia in 1 patient and increased creatine kinase levels in 1 patient) were reported; 3 patients discontinued treatment owing to adverse events.

CONCLUSIONS: In this small, single-group study involving patients with papillary craniopharyngiomas, 15 of 16 patients had a partial response or better to the BRAF-MEK inhibitor combination vemurafenib-cobimetinib. (Funded by the National Cancer Institute and others; ClinicalTrials.gov number, NCT03224767.).

PMID:37437144 | DOI:10.1056/NEJMoa2213329

Int J Surg Pathol. 2023 Jul 12:10668969231185090. doi: 10.1177/10668969231185090. Online ahead of print.

ABSTRACT

Introduction. Pathology plays a major role in the management of patients. Specimen delivery to a pathology laboratory is the first step in the process. Sending materials to the pathology laboratory should be included as part of residency training. The aim of this study was to determine the level of knowledge and daily practice of residents who send materials to pathology laboratory. Methods. A 34-item questionnaire asking questions about biopsy/resection and cytology material handling and transportation was answered by 154 residents. Likert scaling and multiple-choice questions with a single answer were used to evaluate the responses. Their daily routines and levels of knowledge were statistically analyzed. Results. The mean age of the respondents was 29.1 ± 3.04 (range: 24-42 years), and 63% of the residents were male. The residents of the university hospital claimed that the clinical information they had learned about transferring material to the pathology laboratory was “sufficient” or “very sufficient” (statistically significant, P = .04). Correct answers about the process of sending biopsy/resection materials of experienced residents were statistically higher, while there was no statistical significance for questions about cytology materials (P = .005, P = .24, respectively). Conclusion. The pathway to correct diagnosis builds on an understanding of the significance of pathology material. In residency training, knowledge about delivering biopsy/resection material to pathology laboratory is mostly acquired through experience. Experienced residents seem to be less familiar with cytology materials. Clinicopathological meetings may solve the main problems, but both clinics and pathology departments need to emphasize this process.

PMID:37437129 | DOI:10.1177/10668969231185090