Homologous recombination deficiency should be tested for in patients with advanced stage high-grade serous ovarian cancer aged 70 years and over.

OBJECTIVE: Due to limited data on homologous recombination deficiency (HRD) in older patients (≥ 70 years) with advanced stage high grade serous ovarian cancer (HGSC), we aimed to determine the rates of HRD at diagnosis in this age group. METHODS: From the Phase 3 trial VELIA the frequency of HRD and BRCA1/2 pathogenic variants (PVs) was compared between younger (< 70 years) and older participants. HRD and somatic(s) BRCA1/2 pathogenic variants (PVs) were determined at diagnosis using Myriad myChoice® CDx and germline(g) BRCA1/2 PVs using Myriad BRACAnalysis CDx®. HRD was defined if a BRCA PV was present, or the genomic instability score (GIS) met threshold (GIS ≥ 33 & ≥ 42 analyzed). RESULTS: Of 1140 participants, 21% were ≥ 70 years. In total, 26% (n = 298) had a BRCA1/2 PV and HRD, 29% (n = 329) were HRD/BRCA wild-type, 33% (n = 372) non-HRD, and 12% HR-status unknown (n = 141). HRD rates were higher in younger participants, 59% (n = 476/802), compared to 40% (n = 78/197) of older participants (GIS ≥ 42) [p < 0.001]; similar rates demonstrated with GIS ≥ 33, 66% vs 48% [p < 0.001]. gBRCA PVs observed in 24% younger vs 8% of older participants (p < 0.001); sBRCA in 8% vs 10% (p = 0.2559), and HRD (GIS ≥ 42) not due to gBRCA was 35% vs 31% (p = 0.36). CONCLUSIONS: HRD frequency was similar in participants aged < 70 and ≥ 70 years (35% vs 31%) when the contribution of gBRCA was excluded; rates of sBRCA PVs were also similar (8% v 10%), thus underscoring the importance of HRD and BRCA testing at diagnosis in older patients with advanced HGSC given the therapeutic implications.

Early Graft Loss With Suspected Seventh-Day Syndrome Following Pediatric Liver Transplantation.

INTRODUCTION: Allograft dysfunction within the first week posttransplant is an uncommon but known complication following liver transplantation. Seventh-Day Syndrome (7DS) is a rare complication of allograft dysfunction following liver transplantation characterized by the rapid clinical deterioration of a formerly well-functioning allograft within the first week posttransplant. The etiology of 7DS is unknown, and treatment options remain limited. While cases of graft survival have been reported, the risk of mortality remains exceedingly high without urgent retransplantation. METHODS: Patient data was retrospectively analyzed and a literature review performed. RESULTS: We present a unique case of split liver transplantation into two pediatric recipients in which one recipient developed rapidly progressive graft failure approximately 1 week postoperatively requiring urgent retransplantation while the other recipient had an unremarkable postoperative course. Upon clinical manifestation of progressive graft failure, the patient was treated with thymoglobulin, rituximab, intravenous immunoglobulin, and plasmapheresis. Despite this, the patient's clinical status continued to decline and she underwent retransplantation 11 days following her initial liver transplant. CONCLUSION: Seventh-Day Syndrome is a rare complication following liver transplantation that is associated with a high risk of morbidity and mortality. Our case adds to the limited literature on 7DS in children and is the first to report a comparative posttransplant clinical course in two recipients who received split grafts from the same donor.

Idiopathic Granulomatous Mastitis.

Idiopathic granulomatous mastitis (IGM) is a rare, benign inflammatory disorder of the breast that is often underrecognized. The exact etiology and pathophysiology are unknown, but milk stasis is felt to play a role. Classically, this condition is noninfectious, but many cases are noted to be associated with Corynebacterium species. Most patients affected are parous women with a mean age of 35, and many have breastfed within five years of diagnosis. Patients typically present with a painful mass and symptoms of inflammation, and these features can sometimes mimic breast cancer. Biopsy is needed to make a definitive diagnosis, and noncaseating granulomas are found on core biopsy. Many patients have a waxing and waning course over a period of six months to two years. Goal of treatment is to avoid surgery given poor wound healing, high risk of recurrence, and poor cosmetic outcomes. Medical treatment is preferred and includes observation, antibiotics, steroids, and immune modulators such as methotrexate. In more recent years, topical and intralesional steroids have become the treatment of choice, with similar outcomes to oral steroids.

Negative urgency as a state-level process.

OBJECTIVE: Test whether global self-reports of urgency moderated the within-person associations of affect and impulsive behaviors. BACKGROUND: Negative urgency is a personality trait that is a risk factor for a range of psychopathology. Although it is assumed that global self-reports of urgency measure individual tendencies to act more impulsively in the face of negative emotions, evidence from ecological momentary assessment studies is mixed. METHOD: In this Registered Report, we used ecological momentary assessment data from a large sample of young adults (n = 496, age 18-22, 5 surveys per day for 40 days). RESULTS: All forms of momentary impulsivity were impaired in moments when people reported more intense negative emotions, but global self-reports of urgency did not explain individual differences in this association. Moreover, averaged affective states, rather than specific dimensions, affective circumplex, or appraisals, best predicted impulsive states. CONCLUSIONS: Results suggest that face-valid interpretations of global self-report of urgency are inaccurate, and it may be important to understand how some people come to understand themselves as high on urgency rather than assuming that people's self-reports of their motivations are accurate. Momentary experiences of emotions globally impact multiple weakly to moderately associated impulsive behaviors, and future research should seek to understand both when and for whom these associations are strongest.

Supramarginal resection of skull base chordomas: proof of concept and preliminary outcomes.

OBJECTIVE: The mainstay of treatment for skull base chordoma (SBC) is maximal safe resection followed by radiotherapy. However, even after gross-total resection (GTR), the recurrence rate is high due to microscopic disease in the resection margins. Therefore, supramarginal resection (SMR) could be beneficial, as has been shown for sacral chordoma. The paradigm of postoperative radiation therapy for every patient has also begun to change, as molecular profiling has shown variability in the risk of recurrence. The aim of this study was to present the concept of SMR applied to SBC, along with an individualized decision for postoperative radiation therapy. METHODS: This is a retrospective analysis of all SBCs operated on by the senior author between 2018 and 2023. SMR was defined as negative histological margins of bone and/or dura mater, along with evidence of bone resection beyond the tumor margins in the craniocaudal and lateral planes on postoperative imaging. Tumors were classified into 3 molecular recurrence risk groups (group A, low risk; group B, intermediate risk; and group C, high risk). Postoperative radiation therapy was indicated in group C tumors, in group B chordomas without SMR, or in cases of patient preference. RESULTS: Twenty-two cases of SBC fulfilled the inclusion criteria. SMR was achieved in 12 (55%) cases, with a mean (range) amount of bone resection beyond the tumor margins of 10 (2-20) mm (+40%) in the craniocaudal axis and 6 (1-15) mm (+31%) in the lateral plane. GTR and near-total resection were each achieved in 5 (23%) cases. Three (19%) tumors were classified as group A, 12 (75%) as group B, and 1 (6%) as group C. Although nonsignificant due to the small sample size, the trends showed that patients in the SMR group had smaller tumor volumes (13.9 vs 19.6 cm3, p = 0.35), fewer previous treatments (33% vs 60% of patients, p = 0.39), and less use of postoperative radiotherapy (25% vs 60%, p = 0.19) compared to patients in the non-SMR group. There were no significant differences in postoperative CSF leak (0% vs 10%, p = 0.45), persistent cranial nerve palsy (8% vs 20%, p = 0.57), and tumor recurrence (8% vs 10%, p = 0.99; mean follow-up 15 months) rates between the SMR and non-SMR groups. CONCLUSIONS: In select cases, SMR of SBC appears to be feasible and safe. Larger cohorts and longer follow-up evaluations are necessary to explore the benefit of SMR and individualized postoperative radiation therapy on progression-free survival.

Short-term changes in social role statuses across young adulthood and their relation to heavy drinking in a given month.

Young adulthood is a developmental period during which individuals experience shifts in their social roles in various domains, which coincides with a period of time that is also high risk for lifetime peaks in alcohol use. The current study examined age-related changes in heavy episodic drinking (HED) and high-intensity drinking (HID) and associations with short-term (i.e., monthly) variation in young adults' social roles over a 2.5-year period in a community sample of young adults who reported past-year alcohol use (N = 778, baseline age range 18-23). Results showed probabilities of past-month HED and HID changed in a nonlinear fashion across ages 18-26 with greater probabilities of use at younger ages. Most participants did not report being in the same social role status every sampled month, underscoring the presence of short-term role variation. Living with parents and being in a serious romantic relationship in a given month were negatively associated with past-month HED. Living with parents in a given month was also negatively associated with past-month HID. Being a 4-year college student and being employed full-time in a given month were not significantly related to either outcome. Findings provided partial evidence that monthly statuses were associated with heavy drinking. Several avenues for future research are described in light of the findings.

A text message intervention aimed at nurturing peer outreach to help meet drinking limit goals: A remote pilot randomized trial in non-collegiate young adults.

OBJECTIVE: Scalable interventions attempting to nurture peer outreach to help young adults meet drinking limit goals remain under-developed. To address this gap, we developed ASPIRE, a text message intervention focused on coaching individuals to engage with close peers to assist them in meeting drinking limit goals. METHOD: Non-collegiate young adults who had reported one or more heavy drinking days in the preceding month and were at least contemplating change were recruited through social media. Participants were randomly assigned to one of three 6-week text message interventions: Control, Goal Support, or ASPIRE. All groups completed baseline assessments and received weekly text message assessments on Thursdays and Sundays. Control and ASPIRE groups were prompted to complete web-based outcome assessments at 6- and 12-weeks. RESULTS: We enrolled 92 young adults from 31 US states (65% female; 73% White). All groups had high text response rates but intervention usability was sub-optimal. Follow-up rates were 87% at 6-weeks and 79% at 12-weeks. Compared to Control, ASPIRE participants reported significantly more peer support and less peer pressure to drink. ASPIRE exhibited higher goal confidence compared to the Goal Support group. Using multiple imputation, there were no significant differences in drinking outcomes between groups. CONCLUSIONS: Preliminary findings from this pilot study suggest that a text message intervention focused on nurturing peer outreach to help meet drinking limit goals holds promise in altering peer support and pressure as well as boosting drinking limit goal confidence. Design improvements are needed to reduce alcohol consumption.

Large Language Models Versus Expert Clinicians in Crisis Prediction Among Telemental Health Patients: Comparative Study.

BACKGROUND: Due to recent advances in artificial intelligence, large language models (LLMs) have emerged as a powerful tool for a variety of language-related tasks, including sentiment analysis, and summarization of provider-patient interactions. However, there is limited research on these models in the area of crisis prediction. OBJECTIVE: This study aimed to evaluate the performance of LLMs, specifically OpenAI's generative pretrained transformer 4 (GPT-4), in predicting current and future mental health crisis episodes using patient-provided information at intake among users of a national telemental health platform. METHODS: Deidentified patient-provided data were pulled from specific intake questions of the Brightside telehealth platform, including the chief complaint, for 140 patients who indicated suicidal ideation (SI), and another 120 patients who later indicated SI with a plan during the course of treatment. Similar data were pulled for 200 randomly selected patients, treated during the same time period, who never endorsed SI. In total, 6 senior Brightside clinicians (3 psychologists and 3 psychiatrists) were shown patients' self-reported chief complaint and self-reported suicide attempt history but were blinded to the future course of treatment and other reported symptoms, including SI. They were asked a simple yes or no question regarding their prediction of endorsement of SI with plan, along with their confidence level about the prediction. GPT-4 was provided with similar information and asked to answer the same questions, enabling us to directly compare the performance of artificial intelligence and clinicians. RESULTS: Overall, the clinicians' average precision (0.7) was higher than that of GPT-4 (0.6) in identifying the SI with plan at intake (n=140) versus no SI (n=200) when using the chief complaint alone, while sensitivity was higher for the GPT-4 (0.62) than the clinicians' average (0.53). The addition of suicide attempt history increased the clinicians' average sensitivity (0.59) and precision (0.77) while increasing the GPT-4 sensitivity (0.59) but decreasing the GPT-4 precision (0.54). Performance decreased comparatively when predicting future SI with plan (n=120) versus no SI (n=200) with a chief complaint only for the clinicians (average sensitivity=0.4; average precision=0.59) and the GPT-4 (sensitivity=0.46; precision=0.48). The addition of suicide attempt history increased performance comparatively for the clinicians (average sensitivity=0.46; average precision=0.69) and the GPT-4 (sensitivity=0.74; precision=0.48). CONCLUSIONS: GPT-4, with a simple prompt design, produced results on some metrics that approached those of a trained clinician. Additional work must be done before such a model can be piloted in a clinical setting. The model should undergo safety checks for bias, given evidence that LLMs can perpetuate the biases of the underlying data on which they are trained. We believe that LLMs hold promise for augmenting the identification of higher-risk patients at intake and potentially delivering more timely care to patients.

Molecular Characterization and Functional Analysis of a Schistosoma mansoni Serine Protease Inhibitor, Smserpin-p46.

Serine protease inhibitors are a superfamily of proteins that regulate various physiological processes including fibrinolysis, inflammation and immune responses. In parasite systems, serpins are believed to play important roles in parasite colonization, inhibition of host immune serine proteases and penetration of defensive barriers. However, serpins are less well characterized in schistosomes. In this study, a Schistosoma mansoni serpin (Smserpin-p46) containing a 1360 base pair open reading frame, was cloned, expressed and functionally characterized. Bioinformatics analysis revealed that Smserpin-p46 contains the key residues, structural domains and motifs characteristic of inhibitory serpins. Gene expression profiling demonstrated stage-specific expression of Smserpin-p46 with the highest expression in adult male worms. Recombinant Smserpin-p46 (rSmserpin-p46) inhibited both human neutrophil cathepsin G and elastase, key serine proteases involved in NETosis, a program for the formation of neutrophil extracellular traps. Using specific rabbit antiserum, Smserpin-p46 was detected in soluble worm antigen preparation and was localized to the adult worm tegument. Cumulatively, the expression of Smserpin-p46 on the parasite tegument and its ability to inhibit proteases involved in NETosis highlights the importance of this serpin in parasite-host interactions and encourages its further investigation as a candidate vaccine antigen for the control of schistosomiasis.

Proposing a framework to quantify the potential impact of pharmacokinetic drug-drug interactions caused by a new drug candidate by using real world data about the target patient population.

Drug development teams must evaluate the risk/benefit profile of new drug candidates that perpetrate drug-drug interactions (DDIs). Real-world data (RWD) can inform this decision. The purpose of this study was to develop a predicted impact score for DDIs perpetrated by three hypothetical drug candidates via CYP3A, CYP2D6, or CYP2C9 in type 2 diabetes mellitus (T2DM), obesity, or migraine. Optum Market Clarity was analyzed to estimate use of CYP3A, CYP2D6, or CYP2C9 substrates classified in the University of Washington Drug Interaction Database as moderate sensitive, sensitive, narrow therapeutic index, or QT prolongation. Scoring was based on prevalence of exposure to victim substrates and characteristics (age, polypharmacy, duration of exposure, and number of prescribers) of those exposed. The study population of 14,163,271 adults included 1,579,054 with T2DM, 3,117,753 with obesity, and 410,436 with migraine. For T2DM, 71.3% used CYP3A substrates, 44.3% used CYP2D6 substrates, and 44.3% used CYP2C9 substrates. For obesity, 57.1% used CYP3A substrates, 34.6% used CYP2D6 substrates, and 31.0% used CYP2C9 substrates. For migraine, 64.1% used CYP3A substrates, 44.0% used CYP2D6 substrates, and 28.9% used CYP2C9 substrates. In our analyses, the predicted DDI impact scores were highest for DDIs involving CYP3A, followed by CYP2D6, and CYP2C9 substrates, and highest for T2DM, followed by migraine, and obesity. Insights from RWD can be used to estimate a predicted DDI impact score for pharmacokinetic DDIs perpetrated by new drug candidates currently in development. This score can inform the risk/benefit profile of new drug candidates in a target patient population.

Caffeine consumed prior to cardiac stress testing may affect diagnostic accuracy of nuclear medicine myocardial imaging of myocardial ischemia: A systematic review and meta-analysis.

BACKGROUND: Myocardial perfusion imaging (MPI) is a well-established, non-invasive imaging procedure for the diagnosis and evaluation of patients with known or suspected coronary artery disease. With the increasing use of pharmacologic stress agents in myocardial perfusion imaging, strict preparation, including caffeine abstinence, is required. The aim of this review was to determine the effect of caffeine consumed prior to nuclear cardiac stress testing on the diagnostic accuracy. METHODS: Medline, Embase and CINAHL were searched from the earliest available time until August 2022. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2. Data pertaining to diagnostic accuracy were analysed using meta-analysis where appropriate and overall certainty of evidence evaluated using the Grades of Research, Assessment, Development and Evaluation approach. RESULTS: Six studies (307 participants) from a yield of 735 articles were identified. Meta-analysis of two studies found no difference in the left ventricular ejection fraction of patients pre and post caffeine consumption (MD -0.31 %, 95% CI -4.32% to 3.7%). Meta-analysis of three studies found there was uncertainty as to whether caffeine consumption affected reversibility (MD -2.16 segments 95% CI -4.61 to 0.28) and descriptive summary of three studies found mixed results for size of stress defects. CONCLUSION: The low quality evidence synthesized in this systematic review suggests caffeine may affect the diagnostic accuracy in myocardial perfusion imaging for ischemia detection in patients with chest pain and intermediate-to-high risk of coronary artery disease.

Using 3-D-Printed Structures to Evaluate the Potential Causes of the Color Doppler Twinkling Signature.

OBJECTIVE: The color Doppler twinkling artifact has been attributed to existing microbubbles or cavitation occurring on rough objects such as kidney stones, some breast biopsy clips, catheter guidewires and sandpaper. The objective was to investigate the correlation between the surface characteristics of helical constructs with different groove geometries and the occurrence of twinkling, as well as to identify locations conducive to bubble retention and/or cavitation. METHODS: Six half-cylinders were created with a microscale 3-D printer with 5 µm resolution to replicate the geometry of twinkling helical constructs resembling catheter guidewires. Four copies of each marker including a non-twinkling control were printed. The half-cylinders had pitch (peak-to-peak distance) values ranging from 87.5 to 343 µm and amplitude (groove depth) values ranging from 41.5 to 209 µm. The half-cylinders were submerged in degassed water and optically imaged before and after ultrasound insonification to visualize bubbles on the cylinders. The cylinders remained submerged while scanning with the color Doppler mode at frequencies from 3.1 to 6.3 MHz using a GE Logiq E9 scanner and 9L linear array transducer. RESULTS: Two markers exhibited twinkling: one with pitch-to-amplitude ratio of 174/210 µm/µm (0.8) that twinkled only with pre-existing bubbles on the marker; the other had a ratio of 87/87 µm/µm (1.00) that twinkled without pre-existing bubbles on the marker. CONCLUSION: This work provides strong evidence that both existing bubbles and either cavitation or ultrasound wave interactions with patterned or rough surfaces are significant factors in producing the twinkling signature.

Satellite Remote Sensing: A Tool to Support Harmful Algal Bloom Monitoring and Recreational Health Advisories in a California Reservoir.

Cyanobacterial harmful algal blooms (cyanoHABs) can harm people, animals, and affect consumptive and recreational use of inland waters. Monitoring cyanoHABs is often limited. However, chlorophyll-a (chl-a) is a common water quality metric and has been shown to have a relationship with cyanobacteria. The World Health Organization (WHO) recently updated their previous 1999 cyanoHAB guidance values (GVs) to be more practical by basing the GVs on chl-a concentration rather than cyanobacterial counts. This creates an opportunity for widespread cyanoHAB monitoring based on chl-a proxies, with satellite remote sensing (SRS) being a potentially powerful tool. We used Sentinel-2 (S2) and Sentinel-3 (S3) to map chl-a and cyanobacteria, respectively, classified chl-a values according to WHO GVs, and then compared them to cyanotoxin advisories issued by the California Department of Water Resources (DWR) at San Luis Reservoir, key infrastructure in California's water system. We found reasonably high rates of total agreement between advisories by DWR and SRS, however rates of agreement varied for S2 based on algorithm. Total agreement was 83% for S3, and 52%-79% for S2. False positive and false negative rates for S3 were 12% and 23%, respectively. S2 had 12%-80% false positive rate and 0%-38% false negative rate, depending on algorithm. Using SRS-based chl-a GVs as an early indicator for possible exposure advisories and as a trigger for in situ sampling may be effective to improve public health warnings. Implementing SRS for cyanoHAB monitoring could fill temporal data gaps and provide greater spatial information not available from in situ measurements alone.

An Expanded Daily Alcohol Expectancies Measure: Results on the Multilevel Factor Structure and Psychometric Properties.

OBJECTIVE: Alcohol expectancies are beliefs people have about the likelihood of experiencing various positive or negative consequences related to alcohol use. Expectancies have most commonly been treated as trait-like characteristics of individuals, but some researchers have assessed expectancies as state-level characteristics that vary within-persons across days. Previous work developed a 13-item daily alcohol expectancies measure. This study evaluated an expanded version of that measure that includes 10 additional expectancy items. METHOD: Participants were 2- and 4-year college students (N=201; 63.7% female; 55.2% White Non-Hispanic; 75.1% 4-year students) randomized to the control group of a longitudinal study designed to test the efficacy of a just-in-time adaptive intervention delivered via mobile app to reduce high-risk alcohol use. Multilevel exploratory factor analysis was used to determine the factor structure at the daily and person levels. Multilevel models were used to evaluate the convergent validity of the resulting subscales. RESULTS: Two factors, broadly representing positive and negative alcohol expectancies, were retained at the daily and person levels. Composite reliability (ω) estimates ranged from 0.85 to 0.96 and suggested that the reliability of the resulting subscales was good to strong. Associations between the daily expectancy subscales and baseline scores on an established expectancies measure provided preliminary evidence of convergent validity. CONCLUSIONS: Findings indicate that this expanded 23-item daily alcohol expectancies measure is psychometrically sound. This measure is appropriate for use in daily or just-in-time expectancy challenge interventions and is suitable for use among 2- and 4-year college students who drink alcohol regularly and occasionally in heavy quantities and who experience alcohol-related negative consequences.

Predictors of morning cannabis use among young adults: Between- and within-person associations from 24 consecutive months of data.

Morning cannabis use is associated with heavier, frequent cannabis use and more cannabis-related negative consequences, yet little empirical research has examined its predictors. Using 24 months of longitudinal data, the present study tested demographic, psychosocial, and behavioral predictors of morning cannabis use among young adults at the monthly- and person-levels. Young adults (N = 778) were part of a larger study on substance use and social role transitions; participants completed a baseline survey and up to 24 consecutive monthly surveys. Hypotheses were tested using logistic multilevel models to estimate odds ratios for any vs. no morning use in a given month. At the monthly level, social anxiety motives and cannabis use frequency on a given month were positively associated with morning cannabis use. At the person level, typical coping motives, average cannabis use frequency, and male sex were positively associated with morning cannabis use. Findings advance our understanding of individual and psychosocial predictors of morning cannabis use among young adults. Notably, social anxiety motives may represent a malleable target for intervention efforts that could reduce risky use patterns associated with morning use. Such efforts may be especially prudent for young men, as our findings indicated morning cannabis use probabilities were much higher for men than women.

Morning cannabis use in young adults: Associations with overall levels of use, negative consequences, and cannabis use disorder symptoms across 2.5 years.

BACKGROUND: Emerging research suggests morning cannabis use may be associated with using more cannabis and experiencing more cannabis-related consequences. This paper examined whether months when young adults reported morning cannabis use (use between 6:00AM and 12:00PM) were associated with cannabis use frequency, negative cannabis-related consequences, and changes in cannabis use disorder (CUD) symptoms. METHODS: Participants were 778 young adults (Mage=21.11 years, 58.5% female) enrolled in a longitudinal study on substance use and social role transitions. Eligible participants were 18-23 years old at screening and reported past-year alcohol use. Participants completed a baseline survey, 24 consecutive monthly surveys, and a follow-up survey 30 months after baseline. Aims were tested using multilevel models and multiple regression. RESULTS: Analyses were limited to cannabis use months (N=4719; 28.9% of sampled months) and participants who reported cannabis use at least once (N=542; 69.7% of all participants). Morning use was reported in 12.3% of cannabis use months and at least once by 23.6% of participants who reported using cannabis. Relative to non-morning use months, morning use months were associated with greater cannabis use frequency and more negative consequences. However, the association between morning use and negative consequences was not statistically significant after controlling for cannabis use frequency. The percentage of cannabis use months with morning use was positively associated with increased CUD symptoms at the 30-month follow-up, relative to baseline. CONCLUSIONS: Morning cannabis use may be a useful marker of high-risk cannabis use and may contribute to the maintenance and worsening of CUD over time.

Granuloma annulare and possible relation to purified protein derivative administration: a case report.

BACKGROUND: Granuloma annulare is a noninfectious inflammatory granulomatous skin disease characterized by an erythematous or skin colored annulare plaque. The diagnosis of granuloma annulare may be challenging owing to its diverse morphology. In such cases, a correlation between the clinical findings and histologic findings are necessary. CASE PRESENTATION: We report a case of granuloma annulare after purified protein derivative administration. A 56-year-old Caucasian female patient complained of mildly pruritic rashes which started on both arms and lower extremities, and eventually spread to both thighs, the left popliteal region, left upper back, and the right abdominal area. About 6 weeks prior to the eruption of the rashes, the patient had been given a purified protein derivative tuberculin skin test. Biopsy specimens revealed dermal histiocytes palisading around areas of mucin and degenerated collagen, confirming granuloma annulare. After treatment with 0.1% topical triamcinolone acetanide and 500 mg oral metronidazole, the patient's lesions resolved. DISCUSSION: Relatively little is known about granuloma annulare's exact etiology. Granuloma annulare has four variations presenting as either localized, generalized, subcutaneous, or perforating and patch granuloma annulare. The clinical prognosis for granuloma annulare varies according to clinical subtypes. Proposed causal mechanisms of subcutaneous granuloma annulare include physical trauma, infections, immunizations, insect bites, diabetes mellitus, and alterations in the cell-mediated immune responses. The disease likely has an inflammatory component. Clinically, granuloma annulare may be confused with many other skin diseases. CONCLUSION: This case of subcutaneous granuloma annulare was reported since it is a rare dermatologic pathological condition that can be confused with other skin rash disorders. Although it is a benign self-limited disease, definitive diagnosis is important to rule out other pathologies with similar clinical appearances, such as cancer or human immunodeficiency virus (HIV) infection. Diagnostic confirmation is best made through skin biopsy.

Examining whether young adults differ in their endorsement and subjective evaluation of alcohol consequences by age, drinking frequency, and current undergraduate status.

OBJECTIVE: There is considerable variability in how young adults (YAs) perceive drinking-related consequences, and some researcher-identified "negative" consequences are viewed by YAs as neutral or even somewhat positive. Little is known about individual difference factors that may influence subjective evaluations of alcohol consequences. METHOD: We tested whether endorsement and subjective evaluation ('extremely negative' to 'extremely positive') of 24 alcohol-related "negative" consequences differed by age (18-20, 21-27), past 3-month drinking frequency (3x/month or less, weekly or more), and current undergraduate status (4-year undergraduate, non-student). YAs were recruited for a longitudinal ecological momentary assessment study on cognitions and alcohol use. Participants in the analytic sample (N=640; 48.1% White non-Hispanic/Latinx, 50.0% female, mean age=22.2 years, SD=2.3) reported past 3-month drinking. Past 3-month drinking frequency, negative consequences (total and item-level), and subjective evaluations of consequences were assessed cross-sectionally. RESULTS: Compared to YAs 18-20, YAs 21+ experienced fewer total consequences, were significantly less likely to endorse experiencing physical/behavioral consequences, and rated these consequences more negatively if they were endorsed. YAs who drank weekly or more reported experiencing more consequences and were significantly more likely to experience all 24 consequences in comparison to YAs who drank 3x/month or less. Subjective evaluation ratings did not significantly differ by drinking frequency. There were few differences between 4-year undergraduate and non-undergraduates; non-undergraduates rated several health/responsibility-related consequences more negatively. CONCLUSIONS: Findings highlight the importance of identifying individual difference factors that contribute to subjective evaluation ratings, and may be useful for tailoring brief, personalized alcohol interventions for YAs.

A Radiological Clip Design Using Ultrasound Identification to Improve Localization.

OBJECTIVE: We demonstrate the use of ultrasound to receive an acoustic signal transmitted from a radiological clip designed from a custom circuit. This signal encodes an identification number and is localized and identified wirelessly by the ultrasound imaging system. METHODS: We designed and constructed the test platform with a Teensy 4.0 microcontroller core to detect ultrasonic imaging pulses received by a transducer embedded in a phantom, which acted as the radiological clip. Ultrasound identification (USID) signals were generated and transmitted as a result. The phantom and clip were imaged using an ultrasonic array (Philips L7-4) connected to a Verasonics™ Vantage 128 system operating in pulse inversion (PI) mode. Cross-correlations were performed to localize and identify the code sequences in the PI images. RESULTS: USID signals were detected and visualized on B-mode images of the phantoms with up to sub-millimeter localization accuracy. The average detection rate across 30,400 frames of ultrasound data was 98.1%. CONCLUSION: The USID clip produced identifiable, distinguishable, and localizable signals when imaged. SIGNIFICANCE: Radiological clips are used to mark breast cancer being treated by neoadjuvant chemotherapy (NAC) via implant in or near treated lesions. As NAC progresses, available marking clips can lose visibility in ultrasound, the imaging modality of choice for monitoring NAC-treated lesions. By transmitting an active signal, more accurate and reliable ultrasound localization of these clips could be achieved and multiple clips with different ID values could be imaged in the same field of view.

Simultaneous use of alcohol and cannabis and attenuated age-related declines in alcohol and cannabis use disorder symptoms across young adulthood.

Most young adults naturally mature out of high-risk substance use patterns, but it is important to identify factors that may impede normative declines. Use of alcohol and cannabis simultaneously (i.e., simultaneous alcohol and marijuana/cannabis [SAM]) is cross-sectionally associated with alcohol and cannabis concerns, and SAM use increases acute risks at the daily level. However, less is known about long-term risks of SAM use and, specifically, how SAM use relates to maturing out of alcohol and cannabis use. Using four consecutive years of survey data from young adults who reported SAM use (N=409; 1636 responses; aged 18-25 at baseline), we first estimated age-related changes in symptoms of alcohol and cannabis use disorder (AUD/CUD) using multilevel growth modeling. Findings supported a maturing out process, as both AUD and CUD symptom severity significantly declined across young adulthood, on average (4 % and 5 % per year respectively, with significant acceleration). Cross-level interactions tested whether participants' mean SAM use frequency across all four timepoints moderated age-related trajectories in AUD/CUD symptom severity. Significant interactions indicated that, relative to less-frequent SAM use, participants with more frequent SAM use showed less steep declines in AUD (1 % decrease per year vs. 6 % per year) and CUD symptoms (0 % decrease per year vs. 7 % per year); thus, SAM frequency was associated with slower/delayed maturing out of hazardous alcohol and cannabis use. Findings highlight that SAM use may be a correlate or risk-factor for prolonged high-risk substance use during young adulthood that relates to deviations from maturing out processes.