Association of Continuous Glucose Monitoring Metrics With Pregnancy Outcomes in Patients With Preexisting Diabetes.

OBJECTIVE: Continuous glucose monitoring (CGM) improves maternal glycemic control and neonatal outcomes in type 1 diabetes pregnancies compared with self-monitoring of blood glucose. However, CGM targets for pregnancy are based on expert opinion. We aimed to evaluate the association between CGM metrics and perinatal outcomes and identify evidence-based targets to reduce morbidity. RESEARCH DESIGN AND METHODS: This was a retrospective cohort study of pregnant patients with type 1 or 2 diabetes who used real-time CGM and delivered at a U.S. tertiary center (2018-2021). Multiple gestations, fetal anomalies, and early pregnancy loss were excluded. Exposures included time in range (TIR; 65-140 mg/dL), time above range (TAR), time below range (TBR), glucose variability, average glucose, and glucose management indicator. The primary outcome was a composite of fetal or neonatal mortality, large or small for gestational age at birth, neonatal intensive care unit admission, hypoglycemia, shoulder dystocia or birth trauma, and hyperbilirubinemia. Logistic regression estimated the association between CGM metrics and outcomes, and optimal TIR was calculated. RESULTS: Of 117 patients, 16 (13.7%) used CGM before pregnancy and 68 (58.1%) had type 1 diabetes. Overall, 98 patients (83.8%) developed the composite neonatal outcome. All CGM metrics, except TBR, were associated with neonatal morbidity. For each 5 percentage-point increase in TIR, there was 28% reduced odds of neonatal morbidity (odds ratio 0.72, 95% CI 0.58-0.89). The statistically optimal TIR was 66-71%. CONCLUSIONS: Nearly all CGM metrics were associated with adverse neonatal morbidity and mortality and may aid management of preexisting diabetes in pregnancy. Our findings support the American Diabetes Association recommendation of 70% TIR.

An Evaluation of Spin in the Abstracts of Systematic Reviews and Meta-analyses on the Treatment of Psoriasis: A Cross-sectional Analysis.

Spin is a way of reporting that distorts the true findings; we sought to investigate the prevalence of spin in systematic review abstracts on psoriasis treatments and whether study characteristics were associated with spin. We searched MEDLINE and Embase to obtain our sample. Screening and data extraction were performed in a masked duplicate fashion. Each included study was evaluated for the 9 most severe types of spin and other study characteristics. The methodological quality was assessed to explore potential relationships between spin and study quality. Search queries returned 3200 articles, which included 173 systematic reviews. Spin was present in systematic review abstracts. Preventing spin is essential for improving future systematic reviews.

Adjunctive Azithromycin Prophylaxis for Prelabor Cesarean Birth.

OBJECTIVE: To evaluate maternal postoperative infections before and after addition of adjunctive azithromycin to standard antibiotic prophylaxis for prelabor cesarean births. METHODS: We conducted a retrospective cohort study of patients with singleton gestations at more than 23 weeks of gestation who underwent prelabor cesarean birth at a single tertiary care center. Deliveries were categorized as those before implementation of 500 mg intravenous azithromycin in addition to standard preoperative cephalosporin antibiotic prophylaxis (pre-AZI group; January 2013-September 2015) and those after implementation of adjunctive azithromycin (post-AZI group; January 2016-December 2018). Cesarean births from October to December 2015 were excluded as a washout period. The primary outcome was a composite of postcesarean infections (endometritis, superficial or deep wound infections, intra-abdominal abscess, urinary tract infections). Secondary outcomes included composite components, other wound or postoperative complications, and select neonatal morbidities. Outcomes were compared between groups, and adjusted odds ratios (aORs) and 95% CIs were calculated using multivariable analysis. Propensity score matching was performed to assess the robustness our analysis. RESULTS: Of 2,867 delivering patients included for analysis, 1,391 (48.5%) were in the pre-AZI group and 1,476 (51.5%) were in the post-AZI group. Patients in the post-AZI group were older and were more likely to have private insurance, use aspirin, and receive predelivery antibiotics within 2 weeks. There were significantly lower odds of composite infection after azithromycin implementation (3.3% vs 4.8%, aOR 0.60, 95% CI 0.40-0.89), driven by a reduction in wound infection odds (2.4% vs 3.5%, aOR 0.61, 95% CI 0.39-0.98). There were lower odds of other postpartum complications, including wound seroma (0.5% vs 0.9%, aOR 0.34, 95% CI 0.13-0.90) and dehiscence (0.5% vs 1.2%, aOR 0.32, 95% CI 0.13-0.79). There were no differences in select neonatal morbidities between groups. Of 1,138 matching sets in the propensity analysis, the primary outcome remained significantly lower in the post-AZI group (aOR 0.64, 95% CI 0.41-0.99). CONCLUSION: Adopting adjunctive azithromycin for prelabor cesarean deliveries was associated with lower odds of postpartum infection.

Evaluation of Spin in the Abstracts of Systematic Reviews and Meta-Analyses of Atopic Dermatitis Treatments and Interventions.

BACKGROUND: Spin - the misrepresentation of a study's results - has been identified in abstracts of studies focused on a variety of disorders from multiple fields of medicine. OBJECTIVES: This study's primary objective was to evaluate the abstracts of systematic reviews and meta-analyses focused on the treatment of atopic dermatitis for the nine most severe forms of spin. METHODS: We systematically searched Embase and MEDLINE for systematic reviews of atopic dermatitis therapies. Screening and data extraction occurred in a masked, duplicate fashion. Each included study was evaluated for the nine most severe types of spin and other study characteristics. RESULTS: Our searches retrieved 2,456 studies, of which 113 were included for data extraction. Spin was found in 74.3% of our included studies (84/113). Spin type 6 occurred most frequently (68/113, 60.2%). Spin types 1, 2, and 9 were not identified. All industry-funded systematic reviews contained spin in their abstract. The presence of spin was not associated with any specific study characteristics, including the methodological quality of the study. CONCLUSIONS: Severe forms of spin were found in the majority of abstracts for systematic reviews of atopic dermatitis treatments. Steps should be taken to prevent spin to improve the quality of reporting in abstracts.

The Use of Person-Centered Language in Medical Research Journals Focusing on Psoriasis: Cross-sectional Analysis.

BACKGROUND: Person-centered language places a person's identity before any disability or medical condition they may have. Using person-centered language reduces stigma and improves the patient-physician relationship, potentially optimizing health outcomes. Patients with psoriasis often feel stigmatized due to their chronic skin condition. OBJECTIVE: We seek to evaluate the use of person-centered language in psoriasis literature and to explore whether certain article characteristics were associated with non-person-centered language. METHODS: We performed a systematic search on PubMed for recently published articles in journals that regularly publish psoriasis studies. After article reduction procedures, randomization, and screening, we reached our target sample of 400 articles. The following non-person-centered language terms were extracted from each article: "Psoriasis Patient," "Psoriasis subject," "Affected with," "Sufferer," "Suffering from," "Burdened with," "Afflicted with," and "Problems with." Screening and data extraction occurred in a masked duplicate fashion. RESULTS: Of the 400 included articles, 272 (68%) were not adherent to person-centered language guidelines according to the American Medical Association Manual of Style. The most frequent non-person-centered language term was "Psoriasis Patient," found in 174 (43.5%) articles. The stigmatizing language was associated with the type of article and funding status, with original investigations and funded studies having higher rates of stigmatizing language. CONCLUSIONS: Articles about psoriasis commonly use non-person-centered language terms. It is important to shift away from using stigmatizing language about patients with psoriasis to avoid potential untoward influences. We recommend using "patients with psoriasis" or "patient living with psoriasis" to emphasize the importance of person-centered care.

Correction: The Use of Person-Centered Language in Medical Research Journals Focusing on Psoriasis: Cross-sectional Analysis.

[This corrects the article DOI: 10.2196/28415.].

Characterization and Control of Dynamic Rearrangement in a Self-Assembled Antibody Carrier.

Thorough characterization of protein assemblies is required for the control of structure and robust performance in any given application, especially for the safety and stability of protein therapeutics. Here, we report the use of multiple, orthogonal characterization techniques to enable control over the structure of a multivalent antibody carrier for future use in drug delivery applications. The carrier, known as Hex, contains six antibody binding domains that bind the Fc region of antibodies. Using size exclusion chromatography, analytical ultracentrifugation, and dynamic light scattering, we identified the stoichiometry of assembled Hex-antibody complexes and observed changes in the stoichiometry of nanocarriers when incubated at higher temperatures over time. The characterization data informed the modification of Hex to achieve tighter control over the protein assembly structure for future therapeutic applications. This work demonstrates the importance of using orthogonal characterization techniques and observing protein assembly in different conditions over time to fully understand and control structure and dynamics.

An Erythematous papular eruption in a woman with Crohn disease treated with infliximab.

We report the case of a 44-year-old woman with a history of Crohn disease treated with infliximab who presented with erythematous papules and plaques on the upper extremities accompanied by fevers. She was subsequently diagnosed with palisaded neutrophilic and granulomatous dermatitis (PNGD). Whereas immune-complex mediated diseases such as rheumatoid arthritis and systemic lupus erythematosus are most commonly associated, inflammatory bowel disease deserves increased consideration as one of the systemic diseases that can present with PNGD. Additionally, PNGD should remain in the differential diagnosis of cutaneous eruptions that develop in the setting of tumor necrosis factor (TNF) antagonist therapy.

Bright cathodoluminescent thin films for scanning nano-optical excitation and imaging.

Demand for visualizing nanoscale dynamics in biological and advanced materials continues to drive the development of subdiffraction optical probes. While many strategies employ scanning tips for this purpose, we instead exploit a focused electron beam to create scannable nanoscale optical excitations in an epitaxially grown thin-film of cerium-doped yttrium aluminum perovskite, whose cathodoluminescence response is bright, robust, and spatially resolved to 18 nm. We also demonstrate lithographic patterning of the film's luminescence at the nanoscale. We anticipate that converting these films into free-standing membranes will yield a powerful near-field optical microscopy without the complication of mechanical scanning.