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Obesity is associated with respiratory dysfunction. It is a key risk and contributory factor in the sleep related breathing disorders, obstructive sleep apnoea/hypopnoea syndrome (OSAHS) and obesity hypoventilation syndrome (OHS). Weight management is an integral part of the management of these disorders, in addition to continuous positive airways pressure (CPAP) and non-invasive ventilation (NIV). Untreated, these conditions are associated with a high disease burden and as treatment is effective, early recognition and referral is critical. Best practice in on-going care is multidisciplinary. [ABSTRACT FROM AUTHOR]

Background: Retroperitoneal sarcomas are rare soft tissue tumours accounting for 10–15% of soft tissue sarcomas. Patient prognosis and treatment recommendations (including extent of surgery and neoadjuvant strategies) are determined by the pre‐operative histopathological subtype and grade obtained from biopsy and thus it is important to understand the accuracy of biopsy in retroperitoneal masses. Methods: This study presents a case series of primary retroperitoneal sarcomas managed at Peter MacCallum Cancer Centre (PMCC) between 2008 and 2019. Statistical analyses were performed to determine correlation between histopathology from percutaneous biopsy and surgical excision. Results: A total of 117 patients who underwent percutaneous core biopsy and surgical excision of retroperitoneal sarcoma were included. Diagnostic accuracy varied with histopathological diagnosis, but overall precise concordance between biopsy and final histopathology was seen in 61% (κ = 0.57). Biopsy was most sensitive for identifying well‐differentiated liposarcoma (WDLPS) (sensitivity 85%, 95% CI 0.06–0.96) and leiomyosarcoma (sensitivity 81%, 95% CI 0.54–0.96) and was least sensitive for identifying de‐differentiated liposarcoma (DDLPS) (sensitivity 40%, 95% CI 0.25–0.56). Overall agreement between biopsy and final histopathology increased with use of PET/CT scan pre‐biopsy and with use of fluorescence in situ hybridisation testing on biopsy, however, neither test improved recognition of de‐differentiated components within WD/DDLPS on core biopsy. Conclusions: Pre‐operative biopsy is important for clinical decision making in the treatment of retroperitoneal sarcoma. A significant portion of patients with a WDLPS will have a de‐differentiated component identified at the time of resection that was not identified on initial biopsy. [ABSTRACT FROM AUTHOR]

Background: Transrectal ultrasound-guided prostate biopsy (TRUS) is the gold standard for undertaking prostate biopsy, however, it has been associated with higher rates of post-biopsy sepsis than transperineal prostate biopsy (TP). Objective: To compare complication rates between transrectal prostate biopsy and TP for a single surgeon. Materials and Methods: Data were collected for all prostate biopsies undertaken by a single experienced urologist through his private rooms between February 2012 and March 2018. In total, 693 cases were included (560 individual men) in the final analysis (transrectal = 276 and transperineal = 417). All patients were followed up 2 weeks post-biopsy, and complications were recorded (sepsis, urinary tract infection [UTI], bleeding, and acute urinary retention [AUR]). Results: Complications occurred in 37 cases (transrectal = 3 and transperineal = 34). Sepsis occurred in one case following transrectal biopsy (0.36%) and two cases following TP (0.48%). UTI occurred in two cases following transrectal biopsy (0.72%) and two cases following transperineal (0.48%). Bleeding occurred in one case following TP (0.24%). The most common complication was AUR, which occurred in 28 cases following TP (6.71%). Conclusions: Data from this study compared complication rates for both transperineal and transrectal prostate biopsies in a single-surgeon study. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to evaluate if adding SES to risk prediction models based upon traditional risk factors improves the prediction of diabetes.Methods: Risk prediction models without and with individual- and area-level SES predictors were compared using the prospective Multi-Ethnic Study of Atherosclerosis. Cox proportional hazards models were utilized to estimate hazard ratios for SES predictors and to generate 10-year predicted risks for 5,021 individuals without diabetes at baseline followed from 2000 to 2012. C-statistics were used to compare model discrimination, and the proportion of individuals reclassified into higher or lower risk categories with the addition of SES predictors was calculated. The accuracy of risk prediction by SES was assessed by comparing observed and predicted risks across tertiles of the SES variables. Statistical analyses were performed in 2015-2016.Results: Over a median of 9.2 years of follow-up, 615 individuals developed diabetes. Individual- and area-level SES variables did not significantly improve model discrimination or reclassify substantial numbers of individuals across risk categories. Models without SES predictors generally underestimated risk for low-SES individuals or individuals residing in low-SES areas (underestimates ranging from 0.31% to 1.07%) and overestimated risk for high-SES individuals or individuals residing in high-SES areas (overestimates ranging from 0.70% to 1.30%), and the addition of SES variables largely mitigated these differences.Conclusions: Standard diabetes risk models may underestimate risk for low-SES individuals and overestimate risk for those of high SES. Adding SES predictors helps correct this systematic misestimation, but may not improve model discrimination. [ABSTRACT FROM AUTHOR]

Background and aims Vitamin K-dependent protein (VKDP) activity may have a role in preventing cardiovascular calcification, but has not previously been studied in large, generally healthy populations. Methods Using an elevated ankle-brachial index (ABI) as a measure of medial vascular calcification, we performed a case-cohort analysis within the Multi-Ethnic Study of Atherosclerosis, measuring Des-gamma-carboxy prothrombin (DCP) to estimate VKDP activity. In secondary analyses of the weighted subcohort, we examined the cross-sectional associations between DCP and prevalent vascular calcification of the coronary vessels, aortic and mitral valves, and aortic wall, and with vascular stiffness. Results In adjusted analysis, cases (n = 104) had 0.21 ng/ml (−0.94–0.52) lower DCP concentrations than the subcohort (n = 613). Furthermore, amongst the 717 participants in the weighted cohort, VKDP activity was not associated with coronary artery, mitral valve, aortic valve or aortic wall calcification, nor was it associated with vascular stiffness. Conclusions Our negative results do not support a role of circulating VKDP activity in cardiovascular calcification in community-dwelling adults. [ABSTRACT FROM AUTHOR]

Background: The improvement in discrimination gained by adding nontraditional cardiovascular risk markers cited in the 2013 American College of Cardiology/American Heart Association cholesterol guidelines to the atherosclerotic cardiovascular disease (ASCVD) risk estimator (pooled cohort equation [PCE]) is untested.Objectives: This study assessed the predictive accuracy and improvement in reclassification gained by the addition of the coronary artery calcium (CAC) score, the ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) levels, and family history (FH) of ASCVD to the PCE in participants of MESA (Multi-Ethnic Study of Atherosclerosis).Methods: The PCE was calibrated (cPCE) and used for this analysis. The Cox proportional hazards survival model, Harrell's C statistics, and net reclassification improvement analyses were used. ASCVD was defined as myocardial infarction, coronary heart disease-related death, or fatal or nonfatal stroke.Results: Of 6,814 MESA participants not prescribed statins at baseline, 5,185 had complete data and were included in this analysis. Their mean age was 61 years; 53.1% were women, 9.8% had diabetes, and 13.6% were current smokers. After 10 years of follow-up, 320 (6.2%) ASCVD events occurred. CAC score, ABI, and FH were independent predictors of ASCVD events in the multivariable Cox models. CAC score modestly improved the Harrell's C statistic (0.74 vs. 0.76; p = 0.04); ABI, hsCRP levels, and FH produced no improvement in Harrell's C statistic when added to the cPCE.Conclusions: CAC score, ABI, and FH were independent predictors of ASCVD events. CAC score modestly improved the discriminative ability of the cPCE compared with other nontraditional risk markers. [ABSTRACT FROM AUTHOR]

Background: Accurate risk assessment of atherosclerotic cardiovascular disease (ASCVD) is essential to effectively balance the risks and benefits of therapy for primary prevention. Objective: To compare the calibration and discrimination of the new American Heart Association (AHA) and American College of Cardiology (ACC) ASCVD risk score with alternative risk scores and to explore preventive therapy as a cause of the reported risk overestimation using the AHA-ACC-ASCVD score. Design: Prospective epidemiologic study of ASCVD. Setting: MESA (Multi-Ethnic Study of Atherosclerosis), a community-based, sex-balanced, multiethnic cohort. Patients: 4227 MESA participants aged 50 to 74 years and without diabetes at baseline. Measurements: Observed and expected events for the AHAACC- ASCVD score were compared with 4 commonly used risk scores--and their respective end points--in MESA after a 10.2- year follow-up. Results: The new AHA-ACC-ASCVD and 3 older Framingham-based risk scores overestimated cardiovascular events by 37% to 154% in men and 8% to 67% in women. Overestimation was noted throughout the continuum of risk. In contrast, the Reynolds Risk Score overestimated risk by 9% in men but underestimated risk by 21% in women. Aspirin, lipid-lowering or antihypertensive therapy, and interim revascularization did not explain the overestimation. Limitation: Comparability of MESA with target populations for primary prevention and possibility of missed events in MESA. Conclusion: Of the 5 risk scores, 4, including the new AHAACC- ASCVD score, showed overestimation of risk (25% to 115%) in a modern, multiethnic cohort without baseline clinical ASCVD. If validated, overestimation of ASCVD risk may have substantial implications for individual patients and the health care system. Primary Funding Source: National Heart, Lung, and Blood Institute. [ABSTRACT FROM AUTHOR]

This article offers an applied review of key issues and methods for the analysis of longitudinal panel data in the presence of missing values. The authors consider the unique challenges associated with attrition (survey dropout), incomplete repeated measures, and unknown observations of time. Using simulated data based on 4 waves of the Marital Instability Over the Life Course Study ( n = 2,034), they applied a fixed effect regression model and an event-history analysis with time-varying covariates. They then compared results for analyses with nonimputed missing data and with imputed data both in long and in wide structures. Imputation produced improved estimates in the event-history analysis but only modest improvements in the estimates and standard errors of the fixed effects analysis. Factors responsible for differences in the value of imputation are examined, and recommendations for handling missing values in panel data are presented. [ABSTRACT FROM AUTHOR]

Background Ankle joint equinus, or restricted dorsiflexion range of motion (ROM), has been linked to a range of pathologies of relevance to clinical practitioners. This systematic review and metaanalysis investigated the effects of conservative interventions on ankle joint ROM in healthy individuals and athletic populations. Methods Keyword searches of Embase Medline Cochrane and CINAHL databases were performed with the final search being run in August 2013. Studies were eligible for inclusion if they assessed the effect of a non-surgical intervention on ankle joint dorsiflexion in healthy populations. Studies were quality rated using a standard quality assessment scale. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated and results were pooled where study methods were homogenous Results Twenty-three studies met eligibility criteria, with a total of 734 study participants. Results suggest that there is some evidence to support the efficacy of static stretching alone (SMDs: range 0.70 to 1.69) and static stretching in combination with ultrasound (SMDs: range 0.91 to 0.95), diathermy (SMD 1.12), diathermy and ice (SMD 1.16), heel raise exercises (SMDs: range 0.70 to 0.77), superficial moist heat (SMDs: range 0.65 to 0.84) and warm up (SMD 0.87) in improving ankle joint dorsiflexion ROM. Conclusions Some evidence exists to support the efficacy of stretching alone and stretching in combination with other therapies in increasing ankle joint ROM in healthy individuals. There is a paucity of quality evidence to support the efficacy of other non-surgical interventions, thus further research in this area is warranted. [ABSTRACT FROM AUTHOR]

Objectives: The study examined whether progression of coronary artery calcium (CAC) is a predictor of future coronary heart disease (CHD) events.Background: CAC predicts CHD events and serial measurement of CAC has been proposed to evaluate atherosclerosis progression.Methods: We studied 6,778 persons (52.8% female) aged 45 to 84 years from the MESA (Multi-Ethnic Study of Atherosclerosis) study. A total of 5,682 persons had baseline and follow-up CAC scans approximately 2.5 ± 0.8 years apart; multiple imputation was used to account for the remainder (n = 1,096) missing follow-up scans. Median follow-up duration from the baseline was 7.6 (max = 9.0) years. CAC change was assessed by absolute change between baseline and follow-up CAC. Cox proportional hazards regression providing hazard ratios (HRs) examined the relation of change in CAC with CHD events, adjusting for age, gender, ethnicity, baseline calcium score, and other risk factors.Results: A total of 343 and 206 hard CHD events occurred. The annual change in CAC averaged 24.9 ± 65.3 Agatston units. Among persons without CAC at baseline (n = 3,396), a 5-unit annual change in CAC was associated with an adjusted HR (95% Confidence Interval) of 1.4 (1.0 to 1.9) for total and 1.5 (1.1 to 2.1) for hard CHD. Among those with CAC >0 at baseline, HRs (per 100 unit annual change) were 1.2 (1.1 to 1.4) and 1.3 (1.1 to 1.5), respectively. Among participants with baseline CAC, those with annual progression of ≥300 units had adjusted HRs of 3.8 (1.5 to 9.6) for total and 6.3 (1.9 to 21.5) for hard CHD compared to those without progression.Conclusions: Progression of CAC is associated with an increased risk for future hard and total CHD events. [ABSTRACT FROM AUTHOR]

Objectives The study examined whether progression of coronary artery calcium (CAC) is a predictor of future coronary heart disease (CHD) events. Background CAC predicts CHD events and serial measurement of CAC has been proposed to evaluate atherosclerosis progression. Methods We studied 6,778 persons (52.8% female) aged 45 to 84 years from the MESA (Multi-Ethnic Study of Atherosclerosis) study. A total of 5,682 persons had baseline and follow-up CAC scans approximately 2.5 ± 0.8 years apart; multiple imputation was used to account for the remainder (n = 1,096) missing follow-up scans. Median follow-up duration from the baseline was 7.6 (max = 9.0) years. CAC change was assessed by absolute change between baseline and follow-up CAC. Cox proportional hazards regression providing hazard ratios (HRs) examined the relation of change in CAC with CHD events, adjusting for age, gender, ethnicity, baseline calcium score, and other risk factors. Results A total of 343 and 206 hard CHD events occurred. The annual change in CAC averaged 24.9 ± 65.3 Agatston units. Among persons without CAC at baseline (n = 3,396), a 5-unit annual change in CAC was associated with an adjusted HR (95% Confidence Interval) of 1.4 (1.0 to 1.9) for total and 1.5 (1.1 to 2.1) for hard CHD. Among those with CAC >0 at baseline, HRs (per 100 unit annual change) were 1.2 (1.1 to 1.4) and 1.3 (1.1 to 1.5), respectively. Among participants with baseline CAC, those with annual progression of ≥300 units had adjusted HRs of 3.8 (1.5 to 9.6) for total and 6.3 (1.9 to 21.5) for hard CHD compared to those without progression. Conclusions Progression of CAC is associated with an increased risk for future hard and total CHD events. [ABSTRACT FROM AUTHOR]

Secondary respondent data are underutilized because researchers avoid using these data in the presence of substantial missing data. The authors reviewed, evaluated, and tested solutions to this problem. Five strategies of dealing with missing partner data were reviewed: (a) complete case analysis, (b) inverse probability weighting, (c) correction with a Heckman selection model, (d) maximum likelihood estimation, and (e) multiple imputation. Two approaches were used to evaluate the performance of these methods. First, the authors used data from the National Survey of Fertility Barriers (n = 1,666) to estimate a model predicting marital quality based on characteristics of women and their husbands. Second, they conducted a simulation testing the 5 methods and compared the results to estimates where the true value was known. They found that the maximum likelihood and multiple imputation methods were advantageous because they allow researchers to utilize all of the available information as well as produce less biased and more efficient estimates. [ABSTRACT FROM AUTHOR]

Although several methods have been developed to allow for the analysis of data in the presence of missing values, no clear guide exists to help family researchers in choosing among the many options and procedures available. We delineate these options and examine the sensitivity of the findings in a regression model estimated in three random samples from the National Survey of Families and Households (n = 250-2,000). These results, combined with findings from simulation studies, are used to guide answers to a set of 10 common questions asked by researchers when selecting a missing data approach. Modern missing data techniques were found to perform better than traditional ones, but differences between the types of modern approaches had minor effects on the estimates and substantive conclusions. Our findings suggest that the researcher has considerable flexibility in selecting among modern options for handling missing data. [ABSTRACT FROM AUTHOR]

Abstract: In 2001 the CEOs from DuPont, Chad Holliday, and from Procter & Gamble, John Pepper, published a report entitled Sustainability through the Market: Seven Keys to Success. This publication made the business case for meeting the needs of burgeoning populations for goods and services while protecting the natural environment at the same time. Further hundreds of millions are working their way out of poverty and demanding more goods and services. This paper highlights business efforts to meet these demands in a sustainable manner by leveraging market frameworks. This is the essence of the sustainable development argument first posited by Gro Harlem Brundtland in 1987 in the landmark book, Our Common Future. [Copyright &y& Elsevier]

A response from the authors of a research on calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort that was published in a 2014 issue is presented.

An abstract of the article "Interventions for increasing ankle joint dorsiflexion: A systematic review and meta-analysis " by Rebekah Young and colleagues is presented.

We report an evidence-based management algorithm for benign lymphoepithelial cysts (BLEC) of the parotid glands in HIV patients based on long-term outcomes after radiation therapy. From 1987 to 2013, 72 HIV-positive patients with BLEC of the parotid glands treated at our institutions were identified and their medical records were reviewed and analyzed. The primary endpoint of our study was to determine a dose response in HIV patients with BLEC. In group A (≤18 Gy), which received a median dose of 10 Gy (8-18), overall response (OvR), complete response (CR), partial response (PR), and local failure (LF) was experienced by 7, 7, 0, and 93 %, respectively. In group B (≥22.5 Gy), which received a median dose of 24 Gy (22.5-30), OvR, CR, PR, and LF was experienced by 88, 65, 23, and 12 %. Logistic regression revealed that higher dose (≥22.5 Gy) predicted for cosmetic control ( p = 0.0003). Multiple regression analysis revealed higher dose predicted for cosmetic control ( p = 0.0001) after adjusting for confounding variables (age, gender, race, HAART use, BLEC duration, and fractionation size). No patients in either group experienced RTOG grade ≥3 toxicities. A radiation dose of 24 Gy delivered in 12-16 fractions of 1.5-2 Gy per fraction provides long-term cosmetic control in HIV-positive patients with BLEC of the parotid glands. [ABSTRACT FROM AUTHOR]

BACKGROUND: In the general population, the majority of cardiovascular events occur in people at the low to moderate end of population risk distribution. The 2013 American College of Cardiology/American Heart Association guideline on the treatment of blood cholesterol recommends consideration of statin therapy for adults with an estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk >=7.5% based on traditional risk factors. Whether use of nontraditional risk markers can improve risk assessment in those below this threshold for statin therapy is unclear. METHODS AND RESULTS: Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), a population sample free of clinical CVD at baseline, we calibrated the Pooled Cohort Equations (cPCE). ASCVD was defined as myocardial infarction, coronary heart disease death, or fatal or nonfatal stroke. Adults with an initial cPCE <7.5% and elevated levels of additional risk markers (abnormal test) whose new calculated risk was >=7.5% were considered statin eligible: low-density lipoprotein cholesterol >=160 mg/dL; family history of ASCVD; high-sensitivity C-reactive protein >=2 mg/dL; coronary artery calcium score >=300 Agatston units or >=75th percentile for age, sex, and ethnicity; and ankle-brachial index <0.9. We compared the absolute and relative ASCVD risks among those with versus without elevated posttest estimated risk. We calculated the number needed to screen to identify 1 person with abnormal test for each risk marker, defined as the number of participants with baseline cPCE risk <7.5% divided by the number with an abnormal test reclassified as statin eligible. Of 5185 participants not taking statins with complete data (age, 45-84 years), 4185 had a cPCE risk <7.5%. During 10 years of follow-up, 57% of the ASCVD events (183 of 320) occurred among adults with a cPCE risk <7.5%. When people with diabetes mellitus were excluded, the coronary artery calcium criterion reclassified 6.8% upward, with an event rate of 13.3%, absolute risk of 10%, relative risk of 4.0 (95% confidence interval [CI], 2.8-5.7), and number needed to screen of 14.7. The corresponding numbers for family history of ASCVD were 4.6%, 15.1%, 12%, 4.3 (95% CI, 3.0-6.4), and 21.8; for high-sensitivity C-reactive protein criteria, 2.6%, 10%, 6%, 2.6 (95% CI, 1.4-4.8), and 39.2; for ankle-brachial index criteria, 0.6%, 9%, 5%, 2.3 (95% CI, 0.6-8.6), and 176.5; and for low-density lipoprotein cholesterol criteria, 0.5%, 5%, 1%, 1.2 (95% CI, 0.2-8.4), and 193.3, respectively. Of the 3882 with <7.5% cPCE risk, 431 (11.1%) were reclassified to >=7.5% (statin eligible) by at least 1 of the additional risk marker criteria. CONCLUSIONS: In this generally low-risk population sample, a large proportion of ASCVD events occurred among adults with a 10-year cPCE risk <7.5%. We found that the coronary artery calcium score, high-sensitivity C-reactive protein, family history of ASCVD, and ankle-brachial index recommendations by the American College of Cardiology/American Heart Association cholesterol guidelines (Class IIB) identify small subgroups of asymptomatic population with a 10-year cPCE risk <7.5% but with observed ASCVD event rates >7.5% who may warrant statin therapy considerations. [ABSTRACT FROM AUTHOR]

Summary: Objectives: Radiation induced cranial nerve palsy (RICNP) involving the lower cranial nerves (CNs) is a serious complication of head and neck radiotherapy (RT). Recommendations for delineating the lower CNs on RT planning studies do not exist. The aim of the current study is to develop a standardized methodology for contouring CNs IX–XII, which would help in establishing RT limiting doses for organs at risk (OAR). Methods: Using anatomic texts, radiologic data, and guidance from experts in head and neck anatomy, we developed step-by-step instructions for delineating CNs IX–XII on computed tomography (CT) imaging. These structures were then contoured on five consecutive patients who underwent definitive RT for locally-advanced head and neck cancer (LAHNC). RT doses delivered to the lower CNs were calculated. Results: We successfully developed a contouring atlas for CNs IX–XII. The median total dose to the planning target volume (PTV) was 70Gy (range: 66–70Gy). The median CN (IX–XI) and (XII) volumes were 10c.c (range: 8–12c.c) and 8c.c (range: 7–10c.c), respectively. The median V50, V60, V66, and V70 of the CN (IX–XI) and (XII) volumes were (85, 77, 71, 65) and (88, 80, 74, 64) respectively. The median maximal dose to the CN (IX–XI) and (XII) were 72Gy (range: 66–77) and 71Gy (range: 64–78), respectively. Conclusions: We have generated simple instructions for delineating the lower CNs on RT planning imaging. Further analyses to explore the relationship between lower CN dosing and the risk of RICNP are recommended in order to establish limiting doses for these OARs. [ABSTRACT FROM AUTHOR]

Novel technology permits quantification of common carotid artery (CCA) displacement, which is traditionally ignored. We evaluated associations with CCA displacement and cardiovascular disease (CVD) risk and events in a large, multi-ethnic cohort. Right CCA longitudinal displacement (LD), transverse displacement (TD), and grayscale median (GSM) were evaluated using ultrasound speckle-tracking and texture analysis software in 2050 participants. Regression analyses were used to define relationships between CCA LD, TD, GSM, and CVD risk factors. Cox proportional hazards models were used to assess relationships between LD, TD, and incident CVD events. Participants were mean (SD) 64 (10) years old. There were 791 cases with a CVD event over a 12-year median follow-up. The mean LD was 0.29 (0.20) mm. In multivariable models including age, sex, race/ethnicity, heart rate, and CVD risk factors, LD was associated positively with active smoking (β = 0.08, p < 0.001) and inversely with black (β = −0.08, p < 0.001), Chinese (β = −0.05, p < 0.001), and Hispanic (β = −0.04, p < 0.05) race/ethnicities relative to white individuals, heart rate (β = −0.03/10 beats/min, p < 0.001), and diastolic blood pressure (β = −0.01/5 mmHg, p < 0.05). In fully adjusted models, LD and TD were associated with GSM (p < 0.01), but neither predicted incident CVD events (LD: hazard ratio (HR) 0.77 [0.48 to 1.24], p = 0.3; TD: HR 1.12 [0.8 to 1.57], p = 0.5). CCA LD and TD are associated with race/ethnicity and CVD risk factors but not incident CVD events. LD and TD are not measures of arterial stiffness but their association with GSM suggests that lower LD and TD may be related to structural changes within the carotid arterial wall. [ABSTRACT FROM AUTHOR]

Background: Transgender persons are highly victimized, marginalized, disproportionately experience incarceration, and have alarmingly increased rates of HIV infection compared to cis-gender persons. Few studies have examined the HIV care continuum outcomes among transgender women (TW), particularly TW who are involved with the criminal justice (CJ) system. Methods: To improve our understanding of HIV care continuum outcomes and risk behaviors among HIV-infected TW who are involved with the CJ system, we analyzed data from the National Institute on Drug Abuse-supported Seek, Test, Treat, Retain (STTR) Data Harmonization Initiative. Baseline data were pooled and analyzed from three U.S. STTR studies to examine HIV risk and care continuum indicators among CJ-involved HIV-infected TW compared to cisgender men (CM), matched on age (within 5 years) and study at a ratio of 1:5. Results: Eighty-eight TW and 440 CM were included in the study. Among matched participants, TW were more likely to report crack and cocaine use compared to CM (40%,16% respectively, p<0.001); both TW and CM reported high rates of condomless sex (58%, 64%, respectively); TW were more likely than CM to have more than one sexual partner (OR = 2.9, 95% CI: 1.6, 5.2; p<0.001) and have engaged in exchange sex (OR = 3.9, 95% CI: 2.3, 6.6; p<0.001). There were no significant differences between TW and CM in the percentage currently taking ART (52%, 49%, respectively), the mean percent adherence to ART (77% for both groups), and the proportion who achieved viral suppression (61%, 58%, respectively). Conclusions: HIV-infected CJ-involved TW and CM had similar use of ART and viral suppression but TW were more likely than matched CM to engage in exchange sex, have multiple sexual partners, and use crack/cocaine. TW and CM had similarly high rates of condomless sex and use of other drugs. TW require tailored risk reduction interventions, however both CJ-involved TW and CM require focused attention to reduce HIV risk and improve HIV continuum of care outcomes. [ABSTRACT FROM AUTHOR]

In this article we analyze “don't know” responses from three sources of longitudinal data: the National Longitudinal Study of Adolescent Health (n = 14,528), the National Survey of Families and Households (n = 5,488), and the National Health Interview Survey Second Longitudinal Study of Aging (n = 1,131). We asked whether these responses are meaningful in family research, and, if so, how evaluating these responses can contribute to the development of theory, the discovery of novel findings, and identification of sensible methods for analyzing these nebulous responses. We found that “don't know” responses to questions about family members predicted less educational attainment, poor marital quality, and earlier mortality. Results suggest that this response category may have substantive meanings rather than indicating neutral responses or being missing data. [ABSTRACT FROM AUTHOR]

Purpose. Transoral robotic surgery (TORS) has increased in popularity in the management of squamous cell carcinoma of the head and neck. However, TORS does not address the neck or retropharyngeal nodes (RPN). In the current report, we highlight the impact of the lack of adjuvant radiotherapy on RPN recurrence after TORS. Materials and Methods. A 58-year-old Caucasian male presented with squamous cell carcinoma of the head and neck of unknown primary. He was offered radiotherapy as a definitive management for clinical stage T0N2aM0, stage IVA, but he opted to left neck dissection. Follow-up PET-CT scan revealed recurrence in the left base of tongue and right level II lymph node. He was offered radiotherapy which he declined and opted to TORS and right neck dissection. Follow-up PET-CT scan showed recurrence in left RPN for which he underwent salvage concurrent chemoradiotherapy to 70 Gy. Results. After a followup of 9 months from the date of salvage chemoradiotherapy completion, the patient is with no evidence of disease. Conclusions. TORS followed by adjuvant radiotherapy seems reasonable in the context of squamous cell carcinoma of the head and neck due to the odds of RPN involvement. Further reports are warranted to optimize post-TORS adjuvant treatment. [ABSTRACT FROM AUTHOR]

We present here the first report of a metalloporphyrin-based antioxidant that can prevent or delay the onset of autoimmune diabetes. Type 1 diabetes is an autoimmune process whereby T-cells recognize pancreatic beta-cell antigens and initiate a leukocyte infiltrate that produces proinflammatory cytokines and reactive oxygen species (ROS), ultimately leading to beta-cell destruction. Because islet beta-cells have a reduced capacity to scavenge free radicals, they are very sensitive to ROS action. Metalloporphyrin-based superoxide dismutase (SOD) mimics scavenge ROS and protect cells from oxidative stress and apoptosis. To investigate the effect of SOD mimics and the role of oxidative stress in the development of autoimmune diabetes in vivo, we used a diabetogenic T-cell clone, BDC-2.5, to induce rapid onset of diabetes in young nonobese diabetic-severe combined immunodeficient mice (NOD.scid). Disease was significantly delayed or prevented altogether by treatment of recipient mice with an SOD mimic, AEOL-10113, before transfer of the BDC-2.5 clone. To investigate the mechanisms of protection, in vitro assays for T-cell proliferation and gamma-interferon (IFN-gamma) production were carried out using the T-cell clone BDC-2.5. We found that the SOD mimic significantly inhibited antigen-presenting cell-dependent T-cell proliferation and IFN-gamma production in vitro. In addition, pretreatment of lipopolysaccharide (LPS)-stimulated peritoneal macrophages with SOD mimic inhibited the LPS-dependent increase in TNF-alpha as well as the NADPH oxidase-dependent release of superoxide. Finally, this compound protected NIT-1 insulinoma cells from interleukin-1beta and alloxan cytotoxicity in vitro. [ABSTRACT FROM AUTHOR]

Introduction: Novel ultrasound technology permits quantification of common carotid artery (CCA) longitudinal displacement (LD) which has been ignored in traditional carotid artery stiffness measurements. We evaluated associations of CCA LD, CCA echolucency (gray scale median [GSM], an indicator of early arterial injury), cardiovascular disease (CVD) risk factors, and incident CVD events in a large, multi-ethnic cohort initially free of clinical CVD. Methods: Right CCA LD and GSM were evaluated using ultrasound speckle-tracking and texture analysis software in a case-cohort study of 1800 participants in the MESA. Multivariable regression analyses were used to define relationships between CCA LD, GSM, and CVD risk factors. Cox proportional hazards models with inverse probability of selection weighting were used to assess the relationships between LD and incident CVD events. Results: Participants were mean (standard deviation) 64 (10) years old (48% female, 40% White, 28% Black, 22% Hispanic, 10% Chinese). There were 1259 controls and 791 cases with a CVD event over a 12 year median follow-up. Mean LD was 0.29 (0.20) mm. Mean GSM was 61.5 (22.7) units. In a multivariable model that included age, sex, race/ethnicity, heart rate, and CVD risk factors, LD was associated positively with active smoking (β=0.08, p<0.001) and inversely with Black (β=-0.07, p<0.001), Chinese (β=-0.05, p<0.001), and Hispanic (β=-0.05, p<0.05) race/ethnicities relative to Whites, heart rate (β=-0.03/10 beat/min, p<0.001) and diastolic blood pressure (β=-0.01/5 mmHg, p<0.05). In fully adjusted models, LD was associated with GSM (β=2.78/SD; p=0.009), but did not predict incident CVD events (Figure; hazard ratio=0.77, 95% confidence interval 0.48-1.24, p=0.28) Conclusions: CCA LD is associated with race/ethnicity and CVD risk factors. Its strong association with GSM suggests that lower LD represents arterial injury, however LD does not predict incident CVD events. [ABSTRACT FROM AUTHOR]

Background: Grayscale analysis of ultrasound images can characterize arterial wall structure and tissue composition. We hypothesized that measures of carotid artery grayscale texture were associated with cardiovascular disease (CVD) risk factors and could predict CVD events. Methods: Using a case-cohort design, we measured common carotid artery ultrasound images from 1788 participants in Exam 1 of the Multi-Ethnic Study of Atherosclerosis to derive 4 grayscale features: grayscale median (GSM), entropy, gray level difference statistic-contrast (GLDS-CON), and spatial gray level dependence matrices-angular second moment (SGLDM-ASM). CVD risk factor associations were determined by linear regression. Cox proportional hazards models with inverse selection probability weighting and adjustments for age, sex, race/ethnicity, CVD risk factors, and C-reactive protein were used to determine if standardized values for these novel markers could predict incident coronary heart disease (CHD), stroke, and total CVD events over a median 13 years follow-up. Results: Participants were mean (standard deviation, SD) 63.1 (10.3) years of age, 53% female, 32% White, 28% Black, 23% Hispanic, 17% Chinese. There were 283 CHD, 120 stroke, and 416 CVD events. Several associations of GSM, entropy, GLDS-CON, and SGLDM-ASM with CVD risk factors were identified. In fully adjusted models, higher GLDS-CON was associated with a lower risk of incident CHD (HR 0.82, 95% CI 0.71- 0.94, padj=0.005) and CVD events (HR 0.87, 95% CI 0.77-0.98, padj=0.018); higher SGLDM-ASM was associated with a higher risk of CVD events (HR 1.09, 95% CI 1.00-1.19, padj=0.044). Conclusions: Ultrasound carotid artery texture features are associated with CVD risk factors and two, GLDS-CON and SGLDM-ASM, predicted CVD events independent of risk factors, indicating their potential use as novel biomarkers to assess arterial wall composition and CVD risk. [ABSTRACT FROM AUTHOR]

This pilot study determined if the ultrasound texture feature "contrast" was associated with cardiovascular disease (CVD) risk factors and subclinical arterial disease. We evaluated ultrasound images of the right common carotid artery (CCA) from a convenience sample of 151 participants and examined relationships between contrast, CVD risk factors, carotid intima-media thickness (IMT) and coronary artery calcium (CAC). Grey level difference statistics algorithms were used to evaluate the texture feature "contrast" from carotid ultrasound images. Right CCA IMT measurements were made in triplicate in the distal 1 cm segment of the far wall of the artery and CAC score was measured using the Agatston scoring method. In individual models that included age, sex and race, grey level difference statistics contrast (outcome) was associated independently with age [beta (standard error) = –0.87 (0.38) per year; p = 0.02], C-reactive protein [–2.22 (0.96) per mg dl–1; p = 0.02], high-density lipoprotein cholesterol [0.61 (0.24) per mg dl–1; p = 0.01] and CCA IMT [–0.06 (0.02) microns; p = 0.001]. Other CVD risk factors and CAC were not associated independently with contrast. These findings support the potential use of the ultrasound texture contrast for evaluating arterial injury and CVD risk. This paper contributes to the literature in that it describes how the greyscale texture feature "contrast" is related to CVD risk factors. [ABSTRACT FROM AUTHOR]