bluuebunny/crossref_metadata_2025 huggingface dataset:
Video-assisted thoracoscopic surgery lobectomy for giant intralobar pulmonary sequestration: A case report
Authors: Wu Yongyong , Ye Zhongrui , He Zhongliang , He Xueming , Hong Xia , Chen Fei , Xin Shunxin
Published: July 2022

Rationale:

Pulmonary sequestration, which can be divided into 2 main types: intralobar pulmonary sequestration (IPS) and extralobar pulmonary sequestration, is an uncommon congenital condition for which surgical resection is usually indicated. Video-assisted thoracoscopic surgery, as compared with open thoracotomy, has increasingly become the preferred operative procedure in the treatment of PS, owing to less postoperative pain and faster recovery. This report describes a rare and challenging case with a giant IPS undergoing video-assisted thoracic lobectomy.

Patient concerns:

A 39-year old woman suffered from recurrent pneumonia for nearly 3 years. An enhanced computed tomography scan performed in our hospital revealed a 12.0 cm × 10.0 cm-sized IPS in the left lower lobe, supplied by an 8-mm aberrant artery originating from the descending thoracic aorta.

Diagnosis:

Histology of the resected lobe confirmed the diagnosis of giant intralobar pulmonary sequestration associated with infection.

Interventions:

Thoracoscopic left lower lobectomy was performed.

Outcomes:

The patient has been discharged from the hospital on the ninth day after surgery with an uneventful recovery, she was in good health after a 1-year follow-up.

Lessons:

Although full of challenges, thoracoscopic lobectomy for giant IPS is a safe and feasible surgical procedure associated with reduced surgical trauma and postoperative pain as well as improved cosmetic results compared with traditional thoracotomy.
Anterior cervical transpedicular screw fixation system in subaxial cervical spine: A finite element comparative study
Authors: Li Jie , Gan Kaifeng , Chen Binhui , Chen Yilei , Hong Jinjiong , Bei Dikai , Fan Tengdi , Zheng Minzhe , Zhao Liujun , Zhao Fengdong
Published: July 2022

Multilevel cervical corpectomy has raised the concern among surgeons that reconstruction with the anterior cervical screw plate system (ACSPS) alone may fail eventually. As an alternative, the anterior cervical transpedicular screw (ACTPS) has been adopted in clinical practice. We used the finite element analysis to investigate whether ACTPS is a more reasonable choice, in comparison with ACSPS, after a 2-level corpectomy in the subaxial cervical spine. These 2 types of implantation models with the applied 75 N axial pressure and 1 N • m pure moment of the couple were evaluated. Compared with the intact model, the range of motion (ROM) at the operative segments (C4–C7) decreased by 97.5% in flexion-extension, 91.3% in axial rotation, and 99.3% in lateral bending in the ACTPS model, whereas it decreased by 95.1%, 73.4%, 96.9% in the ACSPS model respectively. The ROM at the adjacent segment (C3/4) in the ACTPS model decreased in all motions, while that of the ACSPS model increased in axial rotation and flexion-extension compared with the intact model. Compared to the ACSPS model, whose stress concentrated on the interface between the screws and the titanium plate, the stress of the ACTPS model was well-distributed. There was also a significant difference between the maximum stress value of the 2 models. ACTPS and ACSPS are biomechanically favorable. The stability in reducing ROM of ACTPS may be better and the risk of failure for internal fixator is relatively low compared with ACSPS fixation except for under lateral bending in reconstruction the stability of the subaxial cervical spine after 2-level corpectomy.
The multisystemic effects of oral appliance therapy for obstructive sleep apnea: A narrative review
Authors: Kim Hee Young , Jo Jung Hwan , Chung Jin Woo , Park Ji Woon
Published: July 2022

Obstructive sleep apnea (OSA) is a chronic condition accompanied by repeated obstruction of the upper airway during sleep despite respiratory efforts, resulting in intermittent hypoxemia, altered sleep structure, and sympathetic activation. Previous studies have shown a significant association between OSA and general health issues such as cardiovascular diseases, endocrine disorders, neurocognitive function decline, and poor quality of life. Continuous positive airway pressure (CPAP) has been considered as the first line treatment for OSA. However, accumulating evidence supports the role of oral appliance (OA) therapy, including mandibular advancement devices, as an alternative option for snoring and OSA patients who do not comply with or refuse CPAP usage. Despite a generally favorable outcome of OA therapy for OSA related respiratory indices, studies focusing on the impact of systemic effects of OA therapy in OSA patients are relatively scarce compared with the extensive literature focusing on the systemic effects of CPAP. Therefore, this article aimed to provide an overview of the current evidence regarding the multisystemic effects of OA therapy for OSA.
Plasmatic trimethylamine N-oxide and its relation to stroke: A systematic review and dose-response meta-analysis
Authors: Chen Peng , Guo Zhilei
Published: July 2022

Background:

Elevated circulating concentrations of the gut metabolite, trimethylamine N-oxide (TMAO), were found in patients who experienced stroke. However, it has not been reported whether a high level of TMAO is associated with a significantly increased risk of stroke. This study aimed to review the available scientific evidence about the relationship between TMAO levels and the risk of stroke in a dose-response meta-analysis.

Methods:

The PubMed, Embase, Cochrane library, and China National Knowledge Infrastructure databases were searched for studies starting from September 1996 to December 2020. Nine studies including 4402 subjects were reviewed in this study.

Results:

The results of meta-analysis showed that high levels of circulating TMAO were associated with an increased risk of stroke in patients in the random-effects model (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.12–2.41; P = 0.047). The OR for the prevalence of stroke increased by 48% per 5-μmol/L increment (OR, 1.05; 95% CI, 1.16–1.78; P < 0.001) and by 132% per 10-μmol/L increment (OR, 2.32; 95% CI, 1.38–3.86; P < 0.001) in circulating TMAO concentration according to the dose-response meta-analysis.

Conclusion:

There was a significant association between higher plasma TMAO concentrations and the risk of stroke. Further in-depth studies are warranted to validate this interaction and explore potential mechanisms.
Identification of underlying mechanisms and hub gene-miRNA networks of the genomic subgroups in preeclampsia development
Authors: Zhang Min , Deng Xiaheng , Jiang Ziyan , Ge Zhiping
Published: July 2022

Preeclampsia is a hypertensive disorder of pregnancy that can lead to multiorgan complications in the mother and fetus. Our study aims to uncover the underlying mechanisms and hub genes between genomic subgroups of preeclampsia.

A total of 180 preeclampsia cases from 4 gene profiles were classified into 3 subgroups. Weighted gene coexpression analysis was performed to uncover the genomic characteristics associated with different clinical features. Functional annotation was executed within the significant modules and hub genes were predicted using Cytoscape software. Subsequently, miRNet analysis was performed to identify potential miRNA–mRNA networks.

Three key subgroup-specific modules were identified. Patients in subgroup II were found to develop more severe preeclampsia symptoms. Subgroup II, characterized by classical markers, was considered representative of typical preeclampsia patients. Subgroup I was considered as an early stage of preeclampsia with normal-like gene expression patterns. Moreover, subgroup III was a proinflammatory subgroup, which presented immune-related genomic characteristics. Subsequently, miR-34a-5p and miR-106a-5p were found to be correlated with all 3 significant gene modules.

This study revealed the transcriptome classification of preeclampsia cases with unique gene expression patterns. Potential hub genes and miRNAs may facilitate the identification of therapeutic targets for preeclampsia in future.
Causes of death in primary plasma cell leukemia differ from multiple myeloma: A STROBE-compliant descriptive study based on SEER database
Authors: Ge Xiaoyan , Meng Weihan , Wang Wenbo , Ma Honglin , Zhao Siqi , Cui Kai
Published: July 2022

The primary plasma cell leukemia (pPCL) is a rare but aggressive variant of multiple myeloma (MM). Few studies have focused on the differences in the causes of death between pPCL and MM. This study aimed to compare and evaluate the causes of death of patients with pPCL and MM.

The data were collected from the Surveillance Epidemiology, and End Results (SEER) database. The demographic characteristics, survival, and causes of death in pPCL and MM patients were evaluated and compared. The competing risk regression model was performed to predict the cause of death.

Between 1975 and 2009, the overall mortality rate was 96.13% and 88.71% for pPCL and MM, and the median survival was 9 and 26 months, respectively. In pPCL, leukemia caused 45.05% of the deaths, followed by myeloma (38.83%). In MM, myeloma was the leading cause of death, accounting for 74.89% of the deaths. Older age at diagnosis was a risk factor for dying of leukemia in pPCL patients (HR = 1.49, 95% CI: 1.16–1.91), while older age at death was associated with reduced risk (HR = 0.67, 95% CI: 0.52–0.86). Although the survival of pPCL patients increased with time periods of diagnosis since 1975 to 2009, the risk of dying of leukemia increased with the periods. For MM, most of the demographic characteristics were found to have independently predicting influence on the cause of death.

Patients with pPCL and MM had distinct causes of death. Leukemia was the leading and the most serious cause of death in pPCL patients. The demographic factors could not predict the causes of death in pPCL. More large-scale and multi-center studies are needed to evaluate the effect of novel agents in pPCL patients, especially for patients who have progressed to leukemia.
Application value of contrast-enhanced ultrasound in the diagnosis of peripheral pulmonary focal lesions
Authors: Bai Zina , Liu Tong , Liu Wei , Li Zhensheng , Zheng Hao , Li Xingbin
Published: July 2022

Introduction:

Peripheral pulmonary lesions are encountered frequently in clinical practice. Accurate diagnosis of these lesions is of great importance for clinicians. Ultrasound-guided lung tissue puncture is a reliable method for diagnosing these lesions.

Objectives:

To investigate the application value of contrast-enhanced ultrasound (CEUS) combined with rapid on-site evaluation (ROSE) in the diagnosis of peripheral pulmonary focal lesions.

Methods:

Eighty patients enrolled from July 2020 to June 2021 were divided into two groups: a conventional ultrasound group and a CEUS group. Both groups underwent diagnostic procedures guided by ROSE to improve the success rate of puncture sampling. The success rates and complications in both groups were compared. The results for lesion enhancement, time taken for the contrast agent to reach the lesions (AT) and lung tissues (L-AT), and the difference between these times (∆AT) were compared in the CEUS group.

Results:

The success rate of biopsy in the CEUS group was 97.62%, which was significantly higher than that in the conventional ultrasound group (84%; P < .05). Puncture complications did not occur in the CEUS group and occurred in 5.26% of the cases in the conventional ultrasound group, but the difference was not statistically significant (P > .05). A comparison of enhancement of benign lesions and malignant lesions in the CEUS group showed a statistically significant difference (P < .05). The difference between the AT and ∆AT of benign and malignant lesions was statistically significant (P <.05). The optimal threshold of ∆AT was 2.05 s.

Conclusion:

CEUS combined with ROSE is a very important approach for biopsy in the diagnosis of peripheral pulmonary focal lesions. CEUS has definite clinical value in the diagnosis of benign and malignant lung lesions.
Immune-related pancreatitis due to anti-PD-L1 therapy in a patient with non–small cell lung cancer: A case report
Authors: Malet Julie , Melki Boutheina , Chouabe Stéphane , Deslée Gaëtan
Published: July 2022

Rationale:

Despite clinical-proven benefits of immune checkpoint inhibitors (ICIs) on advanced lung cancer, rare but life-threatening immune-related adverse events (irAEs) have been reported. Pancreatitis is a rare irAE that can occur with any ICI.

Patient concerns:

A 53-year-old man with locally advanced non–small cell lung carcinoma was treated with radiochemotherapy and then durvalumab (anti–programmed cell death ligand 1 therapy). Twelve weeks after the beginning of ICI, he reported abdominal pain and anorexia. Blood test showed high level of lipase. Abdominal computed tomography revealed a swollen pancreas. These findings were confirmed by magnetic resonance cholangiopancreatography and biliopancreatic endoscopic ultrasonography.

Diagnoses:

Grade IV immune-related pancreatitis.

Interventions:

The patient was treated with corticosteroid therapy, resulting in clinical, radiological, and biological improvement.

Outcomes:

During the first month, corticosteroid therapy could not be decreased under 1 mg/kg/d because of symptoms recurrence and lipasemia rerising. Four months after this episode, the patient died from acute ischemia of the lower limbs while he was on <20 mg/d of corticosteroid.

Lessons:

To the best of our knowledge, immune-related pancreatitis has been reported only with anti–programmed cell death 1 or anti–cytotoxic T lymphocyte antigen 4 therapies but never with anti–programmed cell death ligand 1 therapy. It is important to report such rare cases to improve diagnosis and management of irAEs.
Metastatic rectal neuroendocrine carcinoma presenting with treatment-refractory immune thrombocytopenia: A case report and literature review
Authors: Bancheno Wouhabe Marai , Adidam Sneha Rao , Melaku Mekdem Abiy
Published: July 2022

Rationale:

Colorectal neuroendocrine cancer (CRNEC) accounts for < 1% of all colorectal cancers. It presents in advanced stages and carries a risk of poor survival. CRNEC may be diagnosed incidentally on imaging or routine endoscopy. When symptomatic, it may mimic colorectal adenocarcinoma. Syncope and immune thrombocytopenic purpura (ITP) have not previously been reported as clinical presentations.

Patient concerns:

A 57-year-old man with human immunodeficiency virus infection on treatment, seizure and stroke without residue presented for the evaluation of fall and syncope.

Diagnosis:

Physical examination revealed tachycardia, swelling, and ecchymosis of his proximal left lower extremity. Laboratory tests showed a new isolated thrombocytopenia of 26,000/mm3. Computed tomography for a trauma survey showed an incidental left posterior rectal wall mass. After hospital admission, his platelet count dropped to 14,000/mm3. A peripheral blood smear revealed low platelet count, no schistocytes or immature cells. ITP at a high risk for bleeding was diagnosed and treated with standard medical therapy but remained refractory. Bone marrow biopsy showed metastatic neuroendocrine carcinoma, likely from the rectum.

Interventions:

Patient received courses of high-dose dexamethasone and intravenous immunoglobulin. He also receive eleven units of platelet transfusion. A course of rituximab was administered. The platelet count response was suboptimal or short lived with drop to a nadir of 4000/mm3. However, after initiation of Eltrombopag, the thrombocytopenia resolved. Patient was started on etoposide, carboplatin, Atezolizumab. His hospital stay was complicated by neutropenia and sepsis, which was successfully treated.

Outcomes:

He was discharged to subacute rehab in stable condition. About 4 months later, he was readmitted for severe thrombocytopenia, septic shock, and acute respiratory failure. Despite appropriate treatment, the patient deteriorated and expired.

Conclusion:

CRNEC is a rare aggressive disease with dismal outcome that lacks standardized treatment. Metastasis to the bone marrow is uncommon and concomitant ITP has not been reported. We report a rare case of rectal neuroendocrine carcinoma metastatic to bone marrow associated with refractory ITP and review the relevant literature.
IL-6 of follicular fluid and outcome of in vitro fertilization
Authors: Stojanovic Gavrilovic Aleksandra Z. , Cekovic Jelena M. , Parandilovic Aida Z. , Nikolov Aleksandar B. , Sazdanovic Predrag S. , Velickovic Aleksandra M. , Andjelkovic Marija V. , Sorak Marija P.
Published: July 2022

The quality of an oocyte is influenced by its microenvironment, which includes cumulus cells and follicular fluid, as well as cells of the immune system and their products. The ovarian interleukins, which are secreted by the granulosa cells and other immune cells within the ovaries and follicles, regulate various functions between the cells. IL-6 is a cytokine that is present in the follicular fluid and may affect the quality of oocytes. There are some inconsistencies in the literature regarding the concentration of interleukin 6 in the follicular fluid.

The main objective of this study was to examine whether the concentration of interleukin 6 in the follicular fluid affects the outcome of IVF.

This study involved 83 patients who underwent IVF. Follicular fluid was used as the biological material for the analysis. Examination of the obtained follicular fluid and collection of oocytes under a stereomicroscope was performed in the embryological laboratory. The concentration of IL-6 in the follicular fluid was analyzed. IVF and ICSI methods were used as the fertilization methods. Pregnancy was confirmed by the positive serum β-hCG level. The software package SPSS 20 was used for statistical data processing.

Analysis of the follicular fluid samples showed a correlation between the concentration of IL-6 in the follicular fluid and the outcome of IVF. The concentration of IL-6 in the follicular fluid was higher in patients with confirmed pregnancy (9.55 ± 7.47 ng/ml).

Based on our results, we conclude that the concentration of IL-6 affects the outcome of IVF. If the range of IL-6 concentration is between 3,67 ng/ml and 10 ng/ml, we can expect good IVF outcome with vital pregnancy.
Impact of VKORC1, CYP2C9, CYP1A2, UGT1A1, and GGCX polymorphisms on warfarin maintenance dose: Exploring a new algorithm in South Chinese patients accept mechanical heart valve replacement
Authors: Li Jin , Chen Tao , Jie Fangfang , Xiang Haiyan , Huang Li , Jiang Hongfa , Lu Fei , Zhu Shuqiang , Wu Lidong , Tang Yanhua
Published: July 2022

Background:

Warfarin is the most recommended oral anticoagulant after artificial mechanical valve replacement therapy. However, the narrow therapeutic window and varying safety and efficacy in individuals make dose determination difficult. It may cause adverse events such as hemorrhage or thromboembolism. Therefore, advanced algorithms are urgently required for the use of warfarin.

Objective:

To establish a warfarin dose model for patients after prosthetic mechanical valve replacement in southern China in combination with clinical and genetic variables, and to improve the accuracy and ideal prediction percentage of the model.

Methods:

Clinical data of 476 patients were tracked and recorded in detail. The gene polymorphisms of VKORC1 (rs9923231, rs9934438, rs7196161, and rs7294), CYP2C9 (rs1057910), CYP1A2 (rs2069514), GGCX (rs699664), and UGT1A1 (rs887829) were determined using Sanger sequencing. Multiple linear regressions were used to analyze the gene polymorphisms and the contribution of clinical data variables; the variables that caused multicollinearity were screened stepwise and excluded to establish an algorithm model for predicting the daily maintenance dose of warfarin. The ideal predicted percentage was used to test clinical effectiveness.

Results:

A total of 395 patients were included. Univariate linear regression analysis suggested that CYP1A2 (rs2069514) and UGT1A1 (rs887829) were not associated with the daily maintenance dose of warfarin. The new algorithm model established based on multiple linear regression was as follows: Y = 1.081 − 0.011 (age) + 1.532 (body surface area)-0.807 (rs9923231 AA) + 1.788 (rs9923231 GG) + 0.530 (rs1057910 AA)-1.061 (rs1057910 AG)-0.321 (rs699664 AA). The model accounted for 61.7% of individualized medication differences, with an ideal prediction percentage of 69%.

Conclusion:

GGCX (rs699664) may be a potential predictor of warfarin dose, and our newly established model is expected to guide the individualized use of warfarin in clinical practice in southern China.
Assessment of neutrophil to lymphocyte ratio, C-reactive protein, mean platelet volume in obese, and nonobese patients with polycystic ovary syndrome
Authors: Liu Wenhua , Li Songyi , Lou Xiaoming , Li Dingheng , Wang Fang , Zhang Zhifen
Published: July 2022

Polycystic ovary syndrome (PCOS) is associated with low-grade chronic inflammation.

This was a retrospective case–control study.

In the present study, the risk coefficients of neutrophil to lymphocyte ratio (NLR), high-sensitive C-reactive protein (hs-CRP), and mean platelet volume (MPV) in obese patients with PCOS were determined. This study was designed to investigate NLR, hs-CRP, and MPV levels in 68 obese patients with PCOS and 44 nonobese patients with PCOS, and our study group was matched with 47 obese and 43 nonobese controls, respectively.

PCOS group had higher MPV, NLR, insulin, glucose, and HOMA-IR rates than those of the controls. Subgroup analyses revealed that the obese PCOS group had higher NLR, hs-CRP, and MPV levels compared to those of controls. The obese PCOS group had higher NLR, hs-CRP, and MPV levels compared to those of the nonobese PCOS group. The odds ratios and 95% confidence intervals of those variables (NLR, hs-CRP, MPV) were found significant (P < .05). NLR, hs-CRP, and MPV variables were found statistically significant in the analysis of receiver operating characteristics.

Our study demonstrated that NLR, hs-CRP, and MPV levels are increased in patients with obese PCOS.
Cholecystocolic fistula closed using endoscopic therapy alone: A case report
Authors: Kobayashi Kiyoyuki , Kobara Hideki , Ougi Tomohiro , Akaiwa Yuzuru , Nomura Takako , Ougi Maki , Ishikawa Kayo , Ono Masafumi , Kamada Hideki , Masaki Tsutomu
Published: July 2022

Background:

Cholecystocolic fistula (CCF) is a known but rare complication of cholelithiasis. Treatment for CCF is generally surgical. As the number of elderly patients has increased in recent years, many cases require non-surgical treatment; therefore, endoscopic treatment has gained importance.

Patient concerns and diagnosis:

An 87-year-old woman presented with impaired consciousness and symptoms of anorexia. Computed tomography showed cholecystitis and a fistula between the gallbladder and transverse colon. Colonoscopy revealed a CCF. The condition was diagnosed as CCF caused by acute cholecystitis.

Interventions and outcomes:

The patient declined surgery due to her age. Endoscopic fistula closure was performed using a through-the-scope clip after endoscopic naso-gallbladder drainage. Successful closure of the fistula resulted in improvement of cholecystitis and anorexia. The patient was discharged after one month. It has been more than 18 months since the procedure, there has been no recurrence.

Conclusion:

This report on successful endoscopic closure of a CCF indicates that it may be useful for patients who decline surgery.
Upregulated keratin 15 links to the occurrence of lymphovascular invasion, stromal cervical invasion as well as unfavorable survival profile in endometrial cancer patients
Authors: Yang Hongxiang , Li Aijing , Li Aili , Zhao Fei , Zhang Tongyan
Published: July 2022

Keratin 15 (KRT15) overexpression links with tumor initiation, metastasis, and poor survival in several solid carcinomas. While its clinical relevance is scarcely reported in endometrial cancer (EC). Therefore, the current study aimed to investigate the abnormal expression of KRT15 and its correlation with clinical characteristics, survival in EC patients.

Totally, 135 surgical EC patients were enrolled. KRT15 protein expression in formalin-fixed and paraffin-embedded tumor and adjuvant tissues was detected by immunohistochemical staining; meanwhile, KRT15 mRNA expression in fresh-frozen tumor and adjacent tissues was detected by reverse transcription-quantitative polymerase chain reaction.

KRT15 protein and mRNA expressions were higher in tumor tissue compared with adjacent tissue (both P < .001). Elevated KRT15 protein expression was correlated with the occurrence of lymphovascular invasion (P = .010) and more advanced International Federation of Gynecology and Obstetrics stage (P = .018); meanwhile, elevated KRT15 mRNA expression was linked with more advanced International Federation of Gynecology and Obstetrics stage (P = .038) and marginally associated with the occurrence of stromal cervical invasion (P = .052). Besides, KRT15 protein and mRNA expressions were not correlated with other clinical features (all P > .05). KRT15 protein high was marginally correlated with poor accumulating disease-free survival (DFS) (P = .091) and overall survival (OS) (P = .059); meanwhile, the correlation of KRT15 mRNA expression with accumulating DFS (P = .212) and OS (P = .092) was even weaker. However, multivariate Cox’s regressions showed that tumor KRT15 protein (high vs low) was independently correlated with poor DFS (P = .045) and OS (P = .043).

KRT15 is abnormally increased in EC tissue, meanwhile, its upregulation links to the occurrence of lymphovascular invasion, stromal cervical invasion, and poor prognosis in EC patients.
Aortic calcification is associated with coronary artery calcification and is a potential surrogate marker for ischemic heart disease risk: A cross-sectional study
Authors: Hata Yoshiki , Mochizuki Junji , Okamoto Shuichi , Matsumi Hiroaki , Hashimoto Katsushi
Published: July 2022

Coronary artery calcification, an established marker of atherosclerotic plaque burden associated with increased risk of coronary artery disease, is routinely evaluated using electron beam computerized tomography or multidetector computed tomography (CT). However, aortic calcification, which is also a risk factor for adverse cardiac events, is not frequently assessed, despite being easily detected via standard chest radiography. We therefore sought to clarify the association between aortic calcification and significant coronary artery calcification to determine the feasibility of performing chest radiography to evaluate the risk of future cardiovascular events.

Data from 682 consecutive patients who underwent cardiac CT scanning at our institution from May to September 2012 were included in this cross-sectional analysis. Electrocardiographic-gated CT was used to qualitatively evaluate calcification in 6 aortic segments. Cardiac contrast-ehnanced CT was performed to identify significant calcification of the coronary artery. Calcification was quantified by calculating the Agatston score, and the relationship between significant coronary artery calcification and calcification at each aortic site was evaluated.

Among the aortic sites, calcification was most commonly observed in the aortic arch (77.4% of patients). Significant coronary artery calcification was observed in 267 patients (39.1%). Calcification in the ascending aorta, aortic arch, descending aorta, abdominal aorta, and aortic valve were significantly associated with the presence of coronary artery calcification after adjustment for cardiovascular risk factors and statin use (odds ratios [95% confidence intervals] 4.21 [2.55, 6.93], 1.65 [1.01, 2.69], 2.14 [1.36, 3.36], 2.87 [1.83, 4.50], and 3.32 [2.02, 5.46], respectively). Mitral valve calcification was weakly but nonsignificantly associated with coronary artery calcification (odds ratio 1.84 [95% confidence interval 0.94, 3.62]). Calcification of each aortic segment assessed was significantly associated with Agatston score ≥ 100.

Aortic calcification was associated with coronary artery calcification. Calcification of the aortic arch, which can be readily detected by routine chest radiography, may be associated with coronary artery calcification and its assessment should therefore be considered to identify patients at increased risk of cardiovascular events. Further studies are warranted to confirm these findings.
Mendelian randomization study indicates lack of causal associations between iron status and lung cancer
Authors: Qin Hong , Zeng Weibiao , Lou Yongfu
Published: July 2022

Observational studies provided conflicting results on the association between iron status and the risk of lung cancer. The aim of our study was to investigate the effect of genetically determined iron status on lung cancer risk using a mendelian randomization (MR) approach.

Single-nucleotide polymorphisms for iron status were selected from a genome-wide meta-analysis of 48,972 subjects. Genetic association estimates for risk of lung cancer were derived from a Genome-Wide Association Study (GWAS) summary performed by the International Lung Cancer Consortium. The inverse-variance weighted method was used for the main analyses and sensitivity analyses.

MR analysis demonstrated that increased genetically-predicted iron status did not causally increase risk of lung cancer. The odds ratios were 1.11 (95% CI, 0.92, 1.34; P = .26), 0.76 (95% CI, 0.52, 1.12; P = .17), 1.09 (95% CI, 0.86, 1.38; P = .47), and 0.91 (95% CI, 0.81, 1.02; P = .11) per 1 standard deviation increment of serum iron, ferritin, transferrin saturation, and transferrin levels, respectively. No observed indication of heterogeneity (P for Q > 0.05) or pleiotropy (P for intercept > 0.05) were found from the sensitivity analysis.

The MR study indicated that genetic iron status was not causally associated with the risk of lung cancer, the causal relationship between iron status and lung cancer needs to be further elucidated by additional studies that strictly control for confounding factors.
Learning to Lead: 3 Models to Support Public Health Leadership Development
Authors: Brandert Kathleen , Alperin Melissa , Lloyd Laura M. , Rose Barbara , Bekemeier Betty , Rogers Megan , Grimm Brandon
Published: July 2022

Context:

The current public health system is underresourced and understaffed, which has been exacerbated by the coronavirus pandemic. In addition, there has been a decline in the public health workforce at both state and local levels during the last decade. While workforce numbers dwindle, public health systems have to address increasingly complex challenges—such as climate change, chronic diseases, and health equity—challenges that require skilled, adaptive leaders. This article describes the importance of leadership development and how 3 public health training centers (PHTCs) are building leadership skills in the public health workforce.

Program:

To address the need for public health leadership training, the PHTCs in the Health & Human Services (HHS) Regions 4, 7, and 10 all offer public health leadership institutes (PHLIs).

Implementation:

The 3 PHLIs discussed in this article vary in longevity (3-18 years), cohort length (8-12 months), and format (virtual, in-person, and hybrid); yet, all 3 emphasize adaptive leadership through a health equity lens and intentional opportunities to apply skills in practice.

Evaluation:

Each PHLI conducts extensive evaluation based on Kirkpatrick's levels of evaluation and collects common metrics collected by all PHTCs. Data from the PHLIs illustrate high levels of satisfaction with learning, presentation of data, identification of workplace actions, and improvement of subject matter understanding. Each PHLI also has numerous stories of impact.

Discussion:

With public health leaders leaving the workforce and the complexities of practice increasing, leadership training is critical to the current workforce and succession planning. These PHTCs provide a significant, enduring resource toward the development of our nation's public health leaders, as well as meeting the unique needs of their regions' workforces.
Training Public Health Professionals on Adaptive Challenges—An Innovative Approach Using Remote Learning Modalities
Authors: Scallan Walter Elaine J. , Mousavi Christine T. , Elnicki Jill , Davis Sarah
Published: July 2022

Context:

Remote learning opportunities increase access to public health training. Innovative approaches are needed to promote active engagement and learning when tackling more complex, adaptive challenges that are nuanced, lack quick and easy solutions, and require a transformation of values and beliefs.

Program:

The Rocky Mountain Public Health Training Center's (RM-PHTC's) training framework considers the complexity of the challenge (technical to adaptive) when selecting the learning modality. Remote learning opportunities on adaptive challenges are addressed using virtual workshops, online courses, ECHO (Extension for Community Healthcare Outcomes) series, and communities of practice that include a combination of multiple sessions, cohort-based learning, peer learning, practice-based application, and live, interactive sessions. The specific modality chosen depends on the audience and amount of content delivery.

Implementation:

Virtual workshops are single events that encourage peer learning using a blend of instruction and practice-based work. Online courses deliver content to learning cohorts through an online platform combined with multiple, facilitated “live learning sessions.” ECHO series include a short delivery of content, combined with multiple, facilitated, face-to-face, case-based learning sessions with a cohort of peers. Communities of practice encourage a bidirectional peer exchange of resources, approaches, and challenges through online sharing platforms and virtual meetings.

Evaluation:

Using the Kirkpatrick training evaluation model, learners of public health reported that their understanding of the subject matter improved and that they had identified actions that they would apply to their work. In qualitative feedback, learners shared feedback on elements that facilitated learning on adaptive challenges, including interactive breakout groups with peers and practice-based applications.

Discussion:

Remote learning opportunities increase access for public health professionals in rural areas and encourage knowledge exchange region-wide. The RM-PHTC's training framework matches learning opportunities that address adaptive challenges with modalities that include elements that encourage the sharing of ideas and cocreation of solutions.
Creating a Vision for a Healthier Workforce Using a Systems-Based Approach
Authors: Walkner Laurie , May Kathleen , Goldman Bailey , Shultz Hannah , Armbruster Sonja , Grimm Brandon , Hawley Suzanne , Menke Abigail , Orr Shirley , Wilson Kristin , Moody Jeneane , Uden-Holman Tanya , Ginn Kaci
Published: July 2022

Context:

The public health system faces unprecedented challenges due to the pandemic, racism, health inequity, and the politicization of public health. At all levels of the system, the workforce is experiencing distress, burnout, safety issues, and attrition. Public health is being challenged to demonstrate and justify its impact and value, while also leveraging opportunities for learning and system strengthening.

Program:

To explore the current state and identify opportunities to strengthen the public health system, the Region 7 Midwestern Public Health Training Center (MPHTC), with support from Engaging Inquiry, embarked on a distinctive type of systems analysis, called “dynamic systems mapping.”

Implementation:

This approach brought together diverse sectors of public health partners in the region to develop a rich contextual narrative and system-level understanding to highlight and align existing and emergent strengths, areas for growth, and tangible goals for the immediate- and long-term sustainability of local and regional health.

Evaluation:

Focus groups and workshops were conducted with diverse practitioners to identify upstream causes and downstream effects of 11 key forces driving system behavior. These focus groups resulted in the development of a visual map that MPHTC is utilizing to identify opportunities for leverage, develop strategies to maximize the potential impact of these leverage points, as well as facilitate continuous learning.

Discussion:

Public health utilization of systems mapping is a valuable approach to strengthening local and national system responses to current and future public health needs. Outcomes and lessons learned from the systems mapping process are discussed.
Incorporating Systems Thinking Approaches Into Practice-Based Training to Strengthen Policy-Making Skills
Authors: Pirani Sylvia , de Pinho Helen , Arana Mayela , Bhaskar Shwetha , Hale Brittany , Murrman Marita
Published: July 2022

To be successful in advancing public health goals, public health practitioners need to develop competencies associated with policy engagement, a core function of public health work. Theoretical public health policy-making frameworks help practitioners understand steps in the policy process but often fail to reflect on-the-ground realities. Systems thinking approaches are relevant in addressing these complex realities, but training that breaks down seemingly complex concepts and that is useful for practical application is limited. This article discusses how the Region 2 Public Health Training Center developed online practice-based training modules that integrate systems thinking strategies into public health policy making.
Public Health Training Centers' Support for Community Health Workers: Case Studies of Needs Assessment, Training, and Student Field Placement Initiatives
Authors: Lederer Alyssa M. , Barrett Karla Todd , Shorter Charles , Kenefick Hope W. , Kulik Phoebe K. G. , Morales Marcia , Reinschmidt Kerstin M. , Shrestha Sweta
Published: July 2022

Context:

Community health workers (CHWs) are vital frontline public health workers. Given their trusted roles and connection to and understanding of the communities they serve, CHWs are able to link underserved communities to resources and public health agencies. With CHWs' increased prominence in the public health workforce, calls have been made for expanding and supporting CHW training and career development opportunities.

Program:

Public health training centers (PHTCs) are mandated to assess public health workforce needs, provide evidence-based professional development trainings, and increase students' aptitude for working with underserved and underresourced communities through applied practice experiences. Public health training centers can support CHWs in each of these areas.

Design:

Case studies from 3 PHTCs are provided to exemplify how PHTCs are well positioned to support the critical CHW workforce via assessment, training, and student field placements.

Implementation:

A regional needs assessment survey with a designated section for CHWs, the provision of accessible and relevant CHW training, and CHW-focused student field placements were implemented in PHTC Regions 6/South Central, 1/New England, and 5/Great Lakes, respectively.

Evaluation:

The Region 6 needs assessment found that CHWs in Oklahoma had multiple core roles and training interests. A crosswalk of needs and available training in the region guided the creation of tailored CHW trainings. Across 35 CHW-targeted trainings in Region 1, 88.5% of trainees were satisfied with the trainings and identified actions they could take to apply information they learned to their work. Significant improvements (P < .001) in knowledge occurred across the 13 trainings that had pre-/posttests. In Region 5, students engaged with CHW-based organizations in Wisconsin to inform statewide CHW priority action items and deliverables and found the field placements meaningful for their academic experience.

Discussion:

Public health training centers' strengths in workforce development can complement and extend existing efforts to support the CHW workforce.
“Hot Topics in Practice” Webinars: Best Practices for Public Health Webinar Development
Authors: Bekemeier Betty , Rogers Megan H. , Rose Barbara A. , Manchanda Sarah , Andersen Katherine O.
Published: July 2022

Context:

Online education is well researched in some professions; yet, little evidence exists regarding related quality standards for public health practice—particularly with regard to popular webinar offerings. Our objective was to identify and disseminate best practices in public health webinar development for use in development of high-quality, timely webinars for public health practice.

Program:

We assessed data from the Hot Topics in Practice monthly webinar series that included public health professionals primarily from US Northwest states as regular webinar participants.

Implementation:

We conducted a secondary analysis, using participant evaluation data from 9 years of online questionnaires. Subsequent recommendations were developed using participants' responses to postwebinar questionnaires. Thematic analysis of qualitative quarterly reports, as well as 12 years of webinar production team knowledge, supplemented development of best practice recommendations that were not recognized through secondary analysis of respondent questionnaires alone.

Evaluation:

Participant responses tended to be positive when specific practices were followed. These best practices were identified as follows: Address timely topics on current events; Feature only 1 to 2 speakers; Use a limited number of consistently formatted slides; Stay on schedule and make time for audience questions; Minimize technical difficulties; Use effective storytelling to share lessons and key data; Intentionally foster audience engagement (eg, through audience polling, question and answer); Develop clear learning objectives; Provide appropriate resources for continued learning; and Consider audience feedback for continuous improvements.

Discussion:

Our team identified essential elements for creating high-quality, engaging webinars for public health learning. Best practice recommendations resulting from this study address gaps in quality standards and provide knowledge needed for making effective learning accessible to public health practice and supportive of advancing the field. Findings were synthesized into a practice guide, And We're Live: Creating Engaging Public Health Webinars, to aid public health learning.
Engaging Youth in Public Health: Evaluation of Short-term and Long-term Participation in the PATCH Youth Advocacy Fellowship
Authors: Aeschbach Chelsea J. , Kusch Mary M. , Olejniczak Amy B. , Koepsel Erica R.
Published: July 2022

Context:

Authentic youth engagement is widely recognized as an efficacious strategy to promote adolescent health.

Program:

The Providers and Teens Communicating for Health (PATCH) Youth Advocacy Fellowship was created to support Wisconsin's Adolescent Health Program. It strives to bring youth voice to the forefront of adolescent health conversations while also providing young people the knowledge, skills, and opportunities to thrive into adulthood.

Implementation:

The Fellowship hires and trains Wisconsin youth, aged 12 to 21 years, to be a part of community- and state-based adolescent health conversations. Youth meet regularly as a team for ongoing enrichment and are provided opportunities to consult on adolescent-focused projects and initiatives. They are also responsible for independently completing an advocacy learning series, which culminates in an advocacy plan on a topic of personal interest. The Fellowship has been implemented as an extended 9-month program, as well as an expedited 8-week pilot.

Evaluation:

An evaluation was conducted to compare the 8-week pilot (summer 2018) with 51 youth and the sequential 9-month Fellowship (2018-2019) with 12 youth. Based on the quantitative analysis of 2 programmatic evaluations (posttraining and postprogram), both program models showed success. Yet, there were distinct differences among self-reported youth outcomes as well as depth and extent of engagement. Across all 14 domains, the 9-month cohort demonstrated consistently higher mean scores. Half of the domains (7) showed statistically significant differences.

Discussion:

When considering youth engagement, it is important for practitioners to determine the goals, needs, capacity, and resources of both youth and the organization. Engaging youth for shorter-term commitments may serve as an important health education strategy, providing youth important knowledge and skills. Yet, engaging youth for extended periods of time may result in more meaningful engagement, fruitful projects, and substantial changes in positive youth development.
Using Healthy People as a Tool to Identify Health Disparities and Advance Health Equity
Authors: Hoyer Deborah , Dee Elizabeth
Published: July 2022

Background:

As research into the health of different segments of the American population continues to advance, data show inequalities in health outcomes depending on a variety of characteristics, including income and education levels, gender identity, race and ethnicity, and disability status. The Healthy People initiative explores how specific population groups perform for 10-year objectives, including the Leading Health Indicators, which are a broad set of metrics that track issues from health behaviors to determinants of one's health.

Findings:

The data show that, when it comes to health, the playing field for all Americans is not even. At the close of Healthy People 2020, an assessment of the Healthy People 2020 Leading Health Indicators showed that threats to the health of every American vary dependent on who they are, where and how they live, and the community they were born into.

Discussion:

Healthy People 2030 places an emphasis on continued research into these health indicators to uncover how different these realities are for different population groups and to inform and guide effective health policies and interventions in the years ahead.