bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlative light and electron microscopy of poly(ʟ-lactic acid) spherulites for fast morphological measurements using a convolutional neural network
Authors: Konyuba Yuji , Marubayashi Hironori , Haruta Tomohiro , Jinnai Hiroshi
Published: December 2021

Polarized optical microscopy (POM) and transmission electron microscopy (TEM) are widely used for imaging polymer spherulite structures. TEM provides nanometer resolution to image small spherulites of sub-micrometer in diameter, while POM is more suitable for observing large spherulites. However, high-resolution images with a large field of view are challenging to achieve due to the deformations of ultrathin sectioned samples used for TEM observations. In this study, we demonstrated that correlative light and electron microscopy (CLEM) combining POM and TEM could effectively characterize the spherulite structures in a wide range from nanometer to several hundred micrometers that neither TEM nor POM alone could cover. Furthermore, the deformations of the TEM ultrathin sections were corrected by referencing to the POM images at the same position of the sample, and large-area TEM images without deformations were successfully produced. The spherulite structures of poly(ʟ-lactic acid) were successfully analyzed using CLEM and TEM in a wide range of spatial scales at the same field of view. The large-area TEM image (250 µm × 250 µm), consisting of 702 TEM images stitched together, was subjected to machine learning to extract the essential structural information of spherulites. Analysis using the convolutional neural network, a well-known algorithm You Only Look Once (YOLO), demonstrated that it was practical to accurately obtain the diameter distribution and the space-filling factor (relative crystallinity) of the spherulites. This study presents a new approach for acquiring high-resolution images with a large field of view and processing the images at a fast speed.
Cyst and endometriosis of the canal of Nuck: rare differentials for a female groin mass
Authors: Hwang Bridget , Bultitude Jacqueline , Diab Jason , Bean Andrew
Published: December 2021

Cyst of the canal of Nuck is a rare abnormality of the female inguinal canal that can present similarly to a hernia. If incompletely obliterated, the patent canal of Nuck may predispose to an inguinal hernia or hydrocele due to direct communication with the abdominal cavity. Such defects are normally detected and repaired in early childhood but can also present later in adult life. We report the case of a 44-year-old woman who presents with a fluctuant, mobile and irreducible left-sided groin mass. Ultrasound of the groin identified a cystic structure in the canal of Nuck. The patient underwent successful open herniorrhaphy with excision of the cyst and mesh repair of the inguinal canal. Subsequent histopathological examination also revealed concurrent endometriosis of the canal of Nuck. A systematic approach to differential diagnoses for a female groin mass, further investigations and management are discussed.
Trends in Prehospital Blood, Crystalloid, and Colloid Administration in Accordance With Changes in Tactical Combat Casualty Care Guidelines
Authors: Clarke Emily E , Hamm James , Fisher Andrew D , April Michael D , Long Brit J , Mdaki Kennedy S , Hill Ronnie , Bynum James A , Schauer Steven G
Published: December 2021

Introduction

Hemorrhage is the leading threat to the survival of battlefield casualties. This study aims to investigate the types of fluids and blood products administered in prehospital trauma encounters to discover the effectiveness of Tactical Combat Casualty Care (TCCC) recommendations.

Materials and Methods

This is a secondary analysis of a previously described dataset from the Department of Defense Trauma Registry with a focus on prehospital fluid and blood administration in conjunction with changes in the TCCC guidelines. We collected demographic information on each patient. We categorized receipt of each fluid type and blood product as a binary variable for each casualty and evaluated trends over 2007–2020 both unadjusted and controlling for injury severity and mechanism of injury.

Results

Our original dataset comprised 25,897 adult casualties from January 1, 2007 through March 17, 2020. Most (97.3%) of the casualties were male with a median age of 25. Most (95.5%) survived to hospital discharge, and 12.2% of the dataset received fluids of any kind. Medical personnel used crystalloids in 7.4% of encounters, packed red blood cells in 2.0%, and whole blood in 0.5% with very few receiving platelets or freeze-dried plasma. In the adjusted model, we noted significant year-to-year increases in intravenous fluid administration from 2014 to 2015 and 2018 to 2019, with significant decreases noted in 2008–2009, 2010–2012, and 2015–2016. We noted no significant increases in Hextend used, but we did note significant decreases in 2010–2012. For any blood product, we noted significant increases from 2016 to 2017, with decreases noted in 2009–2013, 2015–2016, and 2017–2018. Overall, we noted a general spike in all uses in 2011–2012 that rapidly dropped off 2012–2013. Crystalloids consistently outpaced the use of blood products. We noted a small upward trend in all blood products from 2017 to 2019.

Conclusions

Changes in TCCC guidelines did not immediately translate into changes in prehospital fluid administration practices. Crystalloid fluids continue to dominate as the most commonly administered fluid even after the 2014 TCCC guidelines changed to use of blood products over crystalloids. There should be future studies to investigate the reasons for delay in guideline implementation and efforts to improve adherence.
Assessing Baseline Proficiency of National Guard Combat Medics Due for Recertification: A Pilot Study
Authors: Nichols Ryoma , Noury Luke
Published: December 2021

Introduction

Combat medics, or 68W Healthcare Specialists in the Army, are an early part of a combat casualty’s chain of survival. Their job requires a high degree of competency in emergency medical guidelines established by the Committee of Tactical Combat Casualty Care (CoTCCC) as well as basic bleeding control skills. The American Warfighting Experience for the last two decades highlights just how important these skills are in preventing death on the battlefield. A recent Government Office of Accountability suggests sustainment for critical wartime skills is lacking. This is especially concerning for National Guard Soldiers who must juggle their military obligations with their civilian ones. It is unknown how well-prepared National Guard combat medics are in fulfilling their most critical combat care responsibilities. The current study attempts to address this gap in knowledge by assessing National Guard Soldiers due for their annual recertification.

Materials and Methods

Nine medics due for their annual recertification were recruited for the study. First, they were given a questionnaire intended to gather basic demographic information about their experience and a six-question quiz on current CoTCCC guidelines. The medics were then evaluated on their ability to place a Combat Application Tourniquet on a live person, which was verified by a Doppler microphone. The medics were finally evaluated on their ability to pack a wound with a hemostatic dressing. Statistical analysis was used to determine if experience or frequency of practice over the previous year could predict success.

Results

Medics, on average, were only able to answer an average of 2.2 questions on the quiz correctly. The overall success rate for tourniquet application was 44.4%, and the overall success rate for wound packing was 22.2%. Statistical analysis showed that experience or frequency of practice could not adequately explain the success rates.

Conclusions

A soldier’s experience alone could not predict if the soldier will be successful in performing bleeding control tasks or if they will demonstrate higher levels of casualty care knowledge. Future research is needed in this area to better define recertification and refresher training issues.
The ionophore thiomaltol induces rapid lysosomal accumulation of copper and apoptosis in melanoma
Authors: Scrivner Ottis , Dao Long , Newell-Rogers M Karen , Shahandeh Babbak , Meyskens Frank L , Kozawa Susan Kurumi , Liu-Smith Feng , Plascencia-Villa Germán , José-Yacamán Miguel , Jia Shang , Chang Christopher J , Farmer Patrick J
Published: December 2021

In this report, we investigate the toxicity of the ionophore thiomaltol (Htma) and Cu salts to melanoma. Divalent metal complexes of thiomaltol display toxicity against A375 melanoma cell culture resulting in a distinct apoptotic response at submicromolar concentrations, with toxicity of Cu(tma)2 > Zn(tma)2 >> Ni(tma)2. In metal-chelated media, Htma treatment shows little toxicity, but the combination with supplemental CuCl2, termed Cu/Htma treatment, results in toxicity that increases with suprastoichiometric concentrations of CuCl2 and correlates with the accumulation of intracellular copper. Electron microscopy and confocal laser scanning microscopy of Cu/Htma treated cells shows a rapid accumulation of copper within lysosomes over the course of hours, concurrent with the onset of apoptosis. A buildup of ubiquitinated proteins due to proteasome inhibition is seen on the same timescale and correlates with increases of copper without additional Htma.
Association of Tumor Necrosis Factor α Inhibitor Use with Diagnostic Features and Mortality of Tuberculosis in the United States, 2010–2017
Authors: Katrak Shereen S , Li Rongxia , Reynolds Sue , Marks Suzanne M , Probst Jessica R , Chorba Terence , Winthrop Kevin , Castro Kenneth G , Goswami Neela D
Published: December 2021

Background

An elevated risk of tuberculosis (TB) disease in persons who have received tumor necrosis factor alpha inhibitor medications (TNF-α inhibitors) has been reported for nearly two decades, but clinical diagnostic features and outcomes of TB in this population remain poorly described.

Methods

We analyzed national surveillance data for TB cases among persons aged 15 years and older reported in the United States during 2010–2017 and associated mortality data reported through 2019 to describe the clinical characteristics of those receiving TNF-α inhibitors.

Results

Of 70 129 TB cases analyzed, 504 (0.7%) of the patients had TNF-α inhibitor use reported at TB diagnosis. Patients with TNF-α inhibitor use at TB diagnosis were more likely than TB patients not receiving TNF-α inhibitors to have TB diagnosed in extrapulmonary sites in conjunction with pulmonary sites (28.8% vs 10.0%, P < .001). Patients receiving TNF-α inhibitors were less likely to have acid-fast bacilli noted on sputum smear microscopy (25.6% vs 39.1%, P = .04), and more likely to have drug-resistant disease (13.5% vs 10.0%, P < .001). TB-attributed deaths did not significantly differ between patients receiving and not receiving TNF-α inhibitors (adjusted odds ratio, 1.46 [95% confidence interval, .95–2.26]).

Conclusions

Clinicians evaluating TNF-α inhibitor–treated patients should have a high index of suspicion for TB and be aware that extrapulmonary or sputum smear–negative TB disease is more common in these patients. No significantly diminished survival of TB patients treated with TNF-α inhibitor therapy before TB diagnosis was noted.
Ad Hominem Criminalisation and the Rule of Law: The Egalitarian Case against Knife Crime Prevention Orders
Authors: Green Alex , Hendry Jennifer
Published: December 2021

This article advances a novel account of ad hominem criminalisation that draws upon a distinct theory of the Rule of Law and its egalitarian foundations. Employing the recent and controversial example of Knife Crime Prevention Orders, as established by the Offensive Weapons Act 2019, it argues that the concept of civic equality is central to understanding the vice of ad hominem criminalisation as an aberrant form of government by law. This vice consists in the manner that such criminalisation individualises, differentiates and instrumentalises the regulatory subject, placing them outwith the bounds of civic equality as established by the Rule of Law.
Taking the Fed at its Word: A New Approach to Estimating Central Bank Objectives using Text Analysis
Authors: Shapiro Adam Hale , Wilson Daniel J
Published: December 2021

We propose a new approach to estimating central bank preferences, including the implicit inflation target, that requires no priors on the underlying macroeconomic structure nor observation of monetary policy actions. Our approach entails directly estimating the central bank’s objective function from the sentiment expressed by policymakers in their internal meetings. We apply the approach to the objective function of the U.S. Federal Open Market Committee (FOMC). The results challenge two key aspects of conventional wisdom regarding FOMC preferences. First, the FOMC had an implicit inflation target of approximately $1\frac{1}{2}$$\%$ on average over our baseline 2000–11 sample period, significantly below the commonly assumed value of 2. Second, the FOMC’s loss depends strongly on output growth and stock market performance and less so on their perception of current economic slack.
Paediatric HIV: Correlation between Serum Zinc Levels and CD4 Percentage on Asymptomatic Nigerian Children Living with HIV
Authors: Chukwu Uchenna Kennedy , Nduagubam Obinna Chukwuebuka , Ekwochi Uchenna
Published: December 2021

Objective

This study was conducted to determine the relationship between their serum zinc levels and the CD4% in a cohort children living with HIV.

Methods

One hundred asymptomatic, anti-retroviral Therapy (ART) naïve children living with HIV (participants) aged 5–60 months who were enrolled into the Paediatric HIV clinic of The University of Nigeria Teaching Hospital were recruited in the study over a 10-month period. Blood samples were collected in the morning from non-fasting participants and serum zinc levels were analysed using Atomic Absorption Spectrophotometer. The CD4% was ascertained using the CD4% easy count kit on the Partec® Cyflow Counter machine. Data were analysed using Statistical Package for the Social Sciences version 19.

Result

The median (IQR) serum zinc level for the participants was 55.5 µg/dl (49.75) while their median (IQR) CD4% was 27.79% (18.67). Males had a median (IQR) CD4% of 24.29% (19.10) which was significantly lower than those of females [32% (20.59) (p = 0.047)]. No significant relationship was found between CD4% and zinc levels among the subjects (r = −0.061, p = 0.557).

Conclusion

Serum zinc levels of asymptomatic ART naïve children living with HIV have no relationship with their CD4%.
The 2020 Update on Pressure Injuries: A Review of the Literature
Authors: Saindon Kelley , Berlowitz Dan
Published: December 2021

GENERAL PURPOSE

To provide an update on the epidemiology, pathophysiology, prevention, and patient preferences for care of pressure injuries (PIs).

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this continuing education activity, the participant will:

1. Recognize the risks to ICU patients regarding PIs.

2. Select evidence-based strategies that can help prevent PIs.

3. Identify factors that can contribute to the development of PIs.

4. Choose collaborative approaches when working with a patient who has a PI.

The literature on pressure injuries continues to expand at a rapid rate such that keeping current is a challenge for busy clinicians. In this article, the authors summarize six important articles related to pressure injuries published in 2020. The articles cover a range of topics including epidemiology, pathophysiology, prevention, and patient preferences for care. For each article, a description of the study results is provided along with a comment on why the results are important. This information should help clinicians incorporate these new data into their clinical practice.
Does pH Influence the Bacterial Profile of Chronic Lesions? An Analysis of Venous Ulcer Samples
Authors: Rabello Sergio Fernanda , Caldas Santos Nathália , Andrade Silveira Isabelle , Barreto Pires Bruna Maiara Ferreira , Cavalcanti Valente Gabriel Luis , Arneiro Teixeira Lenise , Lopes Teixeira Felipe , Renato de Paula Geraldo , Baptista de Oliveira Beatriz Guitton Renaud
Published: December 2021

OBJECTIVE

To analyze the pH of venous ulcers and their relationship with the quantitative and qualitative bacterial profile of the wounds.

METHODS

Cross-sectional study carried out through data collection and microbiologic analyses of samples obtained from 35 venous ulcers. Investigators performed pH measurement with indicator strips and collected biologic material using swabs. After aerobic and anaerobic cultivation, colony-forming units (CFUs) were counted and used for bacterial identification via mass spectrometry.

RESULTS

The pH values ranged from 7.9 to 8.7; 8.5 (37.1%) was the most frequent, followed by 8.3 (28.6%). The most common species were Staphylococcus aureus (68.6%), Pseudomonas aeruginosa (62.9%), Proteus mirabilis (45.7%), and Corynebacterium striatum (40.0%). The number of CFUs ranged from 0 to 200,000 in both anaerobiosis and aerobiosis and was predominantly between 1,000 and 10,000 (37.1%) in anaerobiosis and between 10,000 and 100,000 (37.1%) in aerobiosis. No association was found between the different pH values and the variation in CFUs in anaerobiosis (P = .21) and aerobiosis (P = .55) or by bacterial species identified: S aureus (P = .41), P aeruginosa (P = .29), P mirabilis (P = .19), and C striatum (P = .96).

CONCLUSIONS

The pH of venous ulcers did not influence bacterial profile in quantitative or qualitative parameters.
Factors Predicting Pressure Injury Incidence in Older Adults Following Elective Total Hip Arthroplasty: A Longitudinal Study
Authors: Simões João Lindo , Sa-Couto Pedro , Voegeli David
Published: December 2021

OBJECTIVE

To identify the factors associated with pressure injury (PI) development in older adult patients who underwent elective total hip arthroplasty (THA).

METHODS

A nonexperimental longitudinal prospective study was conducted with a sample of 40 patients undergoing elective THA. Patients were evaluated for PI at hospital admission, 24 hours postsurgery, at discharge, and 1 month after surgery.

RESULTS

The incidence of PIs (category 1 or category 2) in this study was 7.9% 24 hours after surgery and 24.3% at discharge. The most common PI location was the sacrum/coccyx or the ischial tuberosity. This study found significant relationships between PIs and female sex (odds ratio [OR], 8.75), body fat mass percentage (OR, 1.15), and the motor score from a Functional Independence Measure scale (OR, 0.89). Finally, the following variables were also associated with PIs (P < .1): skeletal muscle mass (OR, 0.82), lower limb with osteoarthritis weight (OR, 0.61), lower limb without osteoarthritis weight (OR, 0.62), and geriatric depression scale (OR, 1.12).

CONCLUSIONS

This work identifies those patients at higher risk of PI, enabling targeted prevention and treatment in the population of patients undergoing elective THA. The findings of this study are in line with extant literature and suggest that women with a higher percentage of body fat and less mobility had a higher risk of PI.
National Action Towards a World Free of Cervical Cancer for All Women
Authors: Torode Julie , Kithaka Benda , Chowdhury Raveena , Simelela Nothemba , Cruz Jennifer L. , Tsu Vivien D.
Published: December 2021

(Abstracted from Prev Med 2021;144:106313)

Cervical cancer is a preventable disease that continues to have an annual incidence of nearly 600,000 cases with disproportionate disease burden and death occurring in marginalized populations and low- and middle-income countries. Evidence suggests that elimination of cervical cancer as a public health problem is more feasible than it has ever been, and that the incidence can be brought below 4 per 100,000 women globally within a century.
Association of Eviction With Adverse Birth Outcomes Among Women in Georgia, 2000 to 2016
Authors: Himmelstein Gracie , Desmond Matthew
Published: December 2021

(Abstracted from JAMA Pediatr 2021;175(5):494–500)

Median US rent has more than doubled in the past 2 decades, which has led to an increase in eviction rates. Eviction has been associated with numerous adverse health outcomes.
Cervical Cerclage in Twin Pregnancies: An Updated Systematic Review and Meta-analysis
Authors: Liu Yijun , Chen Meng , Cao Tiantian , Zeng Shuai , Chen Ruixin , Liu Xinghui
Published: December 2021

(Abstracted from Eur J Obstet Gynecol Reprod Biol 2021;260:137–149)

Preventing preterm birth (PTB) in twins is important because the risk is significantly higher compared with singleton pregnancies. The effectiveness of cervical cerclage as an option to prevent PTB in twin pregnancies is unclear.
Beyond Diagnostic Yield: Prenatal Exome Sequencing Results in Maternal, Neonatal, and Familial Clinical Management Changes
Authors: Tolusso Leandra K. , Hazelton Paige , Wong Beatrix , Swarr Daniel T.
Published: December 2021

(Abstracted from Genet Med 2021;23:909–917)

At present, it is recommended that chromosomal microarray (CMA) be offered in cases of fetal congenital anomalies. However, 60% to 70% of these cases do not receive a genetic diagnosis following microarray, and exome sequencing is being used more frequently in these cases with a reported diagnostic yield of approximately 10% to 30%.
Genetic Insights Into Biological Mechanisms Governing Human Ovarian Ageing
Authors: Ruth Katherine S. , Day Felix R. , Hussain Jazib
Published: December 2021

(Abstracted from Nature 2021;596:393–397)

The age of reproductive senescence (age of natural menopause [ANM]) in developed countries is approximately 50–52 years; however, natural fertility ceases approximately 10 years before menopause. Societal trends have shifted with women choosing to delay childbearing to older ages, increasing the need for assisted conception technology.
Randomised Controlled Trial of the Effects of Increased Energy Intake on Menstrual Recovery in Exercising Women With Menstrual Disturbances: the ‘REFUEL’ Study
Authors: De Souza Mary Jane , Mallinson Rebecca J. , Strock Nicole C. A. , Koltun Kristen J. , Olmsted Marion P. , Ricker Emily A. , Scheid Jennifer L. , Allaway Heather C. , Mallinson Daniel J. , Don Prabhani Kuruppumullage , Williams Nancy I.
Published: December 2021

(Abstracted from Hum Reprod 2021;36:2285–2297)

The Female Athlete Triad is the condition characterized by the interrelationships among energy deficiency, menstrual dysfunction, and low bone density in exercising women. Increasing energy (ie, food) intake has shown some efficacy in case studies, retrospective cohort studies, and uncontrolled interventions in reversing oligomenorrhea.
Incidence, Prevalence, and Trends in Endometriosis Diagnosis: A United States Population-Based Study From 2006 to 2015
Authors: Christ Jacob P. , Yu Onchee , Schulze-Rath Renate , Grafton Jane , Hansen Kelly , Reed Susan D.
Published: December 2021

(Abstracted from Am J Obstet Gynecol 2021; doi: 10.1016/j.ajog.2021.06.067).

Endometriosis, defined as the presence of extrauterine endometrial tissue, often has serious symptoms that significantly impact the lives of those affected and is associated with annual health care costs of approximately $16,500. Despite the significant societal and individual burden of endometriosis, prevalence and incidence data in the United States are lacking with prevalence rates ranging from 0.8% to 11% and incidence ranging from 4.2 to 35 per 10,000 women-years.
Advancing Equity in Academic Medicine Through Holistic Review for Faculty Recruitment and Retention
Authors: Harris Toi Blakley , Jacobs Negar N. , Fuqua Chantel F. , Lyness Jeffrey M. , Smith Patrick O. , Poll-Hunter Norma I. , Piggott Cleveland , Monroe Alicia D.
Published: December 2021

The Association of American Medical Colleges (AAMC) in 2007 developed the Holistic Review Framework for medical school admissions to increase mission-aligned student diversity. This approach balances an applicant’s experiences, attributes, and metrics during the screening, interview, and selection processes. Faculty recruitment provides its own set of challenges, and there is persistent underrepresentation of certain racial and ethnic minority groups and women in faculty and leadership positions in U.S. academic health centers (AHCs). In 2019, the AAMC initiated a pilot program to adapt and implement the framework for use in faculty recruitment at AHCs. In this Invited Commentary, the authors describe the pilot implementation of the Holistic Review Framework for Faculty Recruitment and Retention and share lessons learned to date.

Although the pilot proceeded during 2020, institutional implementation was impacted by the COVID-19 pandemic and racial justice movement. Pilot institutions encountered hiring freezes, reductions in funding, and restrictions on in-person meetings due to COVID-19 that resulted in both barriers and opportunities in implementing the framework. Renewed commitment to racial justice was associated with increased momentum and urgency for the implementation of faculty holistic review at the majority of pilot institutions. Common themes from the pilot leads’ experiences included the importance of achieving “buy in,” having a dedicated implementation team, and being explicit about core values. Other themes included the importance of adaptability and flexibility to meet the needs of different institutions and mission areas. The faculty holistic review framework has shown promise as an approach to advancing faculty diversity goals. The pilot institutions will continue to share best practices, track outcomes, implement quality improvement, and disseminate findings to assist other institutions and health care communities with their endeavors to recruit and retain diverse faculty.
Pan-immune-inflammation Value and Prognosis in Patients With Esophageal Cancer
Authors: Baba Yoshifumi , Nakagawa Shigeki , Toihata Tasuku , Harada Kazuto , Iwatsuki Masaaki , Hayashi Hiromitsu , Miyamoto Yuji , Yoshida Naoya , Baba Hideo
Published: December 2021

Mini-abstract:

The pan-immune-inflammation value was associated with clinical outcomes and tumor-infiltrating lymphocytes in 866 esophageal cancers. Systemic immune competence may influence patient prognosis through local immune response.

Objective:

To examine the relationship between the pan-immune-inflammation value (PIV), tumor immunity, and clinical outcomes in 866 patients with esophageal cancer.

Background:

The PIV, calculated from all immune-inflammatory cells in the peripheral blood count, is a recently proposed marker for clinical outcomes in some types of cancers. Nonetheless, the prognostic significance of PIV in esophageal cancer remains unclear.

Methods:

In the derivation cohort (n = 433), we set the optimal cutoff value using a time-dependent receiver operating characteristic (ROC) curve. In the validation cohort (n = 433), the relationships between the PIV, tumor-infiltrating lymphocytes (TILs), CD8 expression by immunohistochemical staining, and patient prognosis were examined.

Results:

The area under the ROC curve for the PIV at 5 years was 0.631 in the derivation cohort. The validation cohort, divided into PIV-low cases (n = 223) and PIV-high cases (n = 210), showed significantly worse overall survival (log-rank P = 0.0065; hazard ratio [HR]: 1.48; 95% confidence interval [CI]: 1.12–1.98; P < 0.001; multivariate HR: 1.41; 95% CI: 1.05–1.90; P = 0.023). The prognostic effect of the PIV was not significantly modified by any clinical characteristics (P for interaction > 0.05). The PIV-high cases were significantly associated with a low TIL status (P < 0.001) and low CD8-positive cell counts (P = 0.011).

Conclusions:

The PIV was associated with clinical outcomes in esophageal cancer, supporting its role as a prognostic biomarker. Considering the relationship between the PIV and TILs, systemic immune competence may influence patient prognosis through a local immune response.
Tenofovir vs. entecavir on recurrence of hepatitis B virus-related hepatocellular carcinoma beyond Milan criteria after hepatectomy
Authors: Shen Junyi , Qi Weili , Dai Junlong , Leng Shusheng , Jiang Kangyi , Zhang Yu , Ran Shun , Li Chuan , Wen Tianfu
Published: December 2021

Background:

Hepatectomy for hepatocellular carcinoma (HCC) beyond the Milan criteria is shown to be beneficial. However, a high rate of post-operative HCC recurrence hinders the long-term survival of the patients. This study aimed to investigate and compare the impacts of tenofovir (TDF) and entecavir (ETV) on the recurrence of hepatitis B viral (HBV)-related HCC beyond the Milan criteria.

Methods:

Data pertaining to 1532 patients who underwent hepatectomy and received antiviral therapy between January 2014 and January 2019 were collected from five centers. Recurrence-free survival (RFS) analysis was performed using the Kaplan–Meier method. Cox proportional hazards regression analysis was performed to determine prognostic factors for HCC recurrence.

Results:

The analysis incorporates 595 HBV-related HCC patients. The overall 5-year RFS was 21.3%. Among them, 533 and 62 patients received ETV and TDF treatment, respectively. The 1-, 3-, and 5-year RFS rates were 46.3%, 27.4%, and 19.6%, respectively, in the ETV group compared with 65.1%, 41.8%, and 37.2%, respectively, in the TDF group (P < 0.001). Multivariate analysis showed that TDF treatment (hazard ratio [HR]: 0.604, P = 0.005), cirrhosis (HR: 1.557, P = 0.004), tumor size (HR: 1.037, P = 0.008), microvascular invasion (MVI) (HR: 1.403, P = 0.002), portal vein tumor thrombus (PVTT) (HR: 1.358, P = 0.012), capsular invasion (HR: 1.228, P = 0.040), and creatinine levels (CREA) (HR: 0.993, P = 0.031) were statistically significant prognostic factors associated with RFS.

Conclusions:

Patients with HCC beyond the Milan criteria exhibited a high rate of HCC recurrence after hepatectomy. Compared to the ETV therapy, TDF administration significantly lowered the risk of HCC recurrence.
Assessing the Prevalence of Microaggressions in Plastic Surgery Training: A National Survey
Authors: Goulart Micheline F. , Huayllani Maria T. , Balch Samora Julie , Moore Amy M. , Janis Jeffrey E.
Published: December 2021

Background:

There has been increased awareness of microaggressions occurring during medical training. However, the prevalence and characteristics of microaggressions specifically in plastic surgery residency remain unknown. We aimed to fill this literature gap by conducting a nationwide survey to better understand and characterize microaggressions in plastic surgery training.

Methods:

A survey was distributed between March and May 2021 via the American Society of Plastic Surgeons Resident Representatives to 1014 integrated and 214 independent track plastic surgery trainees in the United States. Multiple Pearson’s chi-square of independence and Fisher exact tests evaluated comparisons of microaggressions by sex, race, Hispanic origin, sexual orientation, and year in training. A multivariate regression analysis assessed associations between variables.

Results:

One hundred twenty-five participants responded to the survey (response rate: 10.2%). Of those who responded, 68.8% had experienced microaggressions in the past year. Female trainees experienced microaggressions more frequently than male trainees (P < 0.05). Asian trainees had higher odds to be a target of microaggressions compared with White trainees (P = 0.013). Nonheterosexual trainees were more likely to have experienced microaggressions compared with heterosexual trainees (P < 0.05). Independent trainees were more likely to experience microaggressions than PGY 1–2 and 3–4 integrated residents (P < 0.05).

Conclusions:

Approximately seven in every 10 trainees stated that they experienced microaggressions in the past year. Females, racial minorities, sexual minorities, and independent trainees had higher odds of reporting that they experienced microaggressions. Further studies are needed to assess the implementation of strategies that address this problem to resolve inequities.
PREVALENCE AND CHARACTERISTICS OF MULTIFOCAL CHOROIDITIS/PUNCTATE INNER CHOROIDOPATHY IN PATHOLOGIC MYOPIA EYES WITH PATCHY ATROPHY
Authors: Hady Shymaa K. , Xie Shiqi , Freund K. Bailey , Cunningham Emmett T. , Wong Chee Wai , Cheung Chui Ming Gemmy , Kamoi Koju , IGARASHI-YOKOI Tae , Ali Omar M. , Wasfi Ehab I. , Rateb Mahmoud F. , Ohno-Matsui Kyoko
Published: December 2021

Purpose:

To determine the prevalence and characteristics of multifocal choroiditis/punctate inner choroidopathy (MFC/PIC) in eyes with patchy atrophy because of pathologic myopia.

Methods:

Five hundred eyes of 253 patients with patchy atrophy were examined between 2014 and 2020 at the Advanced Clinical Center for Myopia. The main outcome measures included the prevalence and characteristics of active MFC/PIC lesions diagnosed by optical coherence tomography.

Results:

Fifty-five of the 500 eyes (11%) diagnosed with patchy atrophy had optical coherence tomography features of active MFC/PIC lesions, such as focal elevations of the retinal pigment epithelium filled with medium hyperreflectivity material, curvilinear scars (Schlaegel lines), and/or areas of outer retinal atrophy. At the time when the MFC/PIC was diagnosed, the mean age was 57.3 ± 12.0 years, and the mean axial length was 29.2 ± 1.8 mm. Macular neovascularization was found in 45 of eyes (81.8%) with MFC/PIC versus 151 eyes without such findings (33.9%; P < 0.001). In 25 of the 55 eyes (45.5%), active MFC/PIC lesions were found before the development of the patchy atrophy. The Bruch membrane defects were colocated with these lesions.

Conclusion:

Active MFC/PIC lesions were identified in a minority of eyes with pathologic myopia, and a subset of these lesions were observed to progress to findings indistinguishable from myopic patchy atrophy. Evidence of MFC/PIC in eyes with pathologic myopia appeared to be a risk factor for the development of macular neovascularization.
The Utility of Nursing Notes Among Medicare Patients With Heart Failure to Predict 30-Day Rehospitalization
Authors: Kang Youjeong , Topaz Maxim , Dunbar Sandra B. , Stehlik Josef , Hurdle John
Published: December 2021

Background

For patients with heart failure (HF), there have been efforts to reduce the risk of 30-day rehospitalization, such as developing predictive models using electronic health records. Few previous studies used clinical notes to predict 30-day rehospitalization.

Objective

The aim of this study was to assess the utility of nursing notes versus discharge summaries to predict 30-day rehospitalization among patients with HF.

Methods

In this pilot study, we used free-text discharge summaries and nursing notes collected from a tertiary hospital. We randomly selected 500 Medicare patients with HF. We followed the natural language processing and machine learning pipeline for data analysis.

Results

Thirty-day rehospitalization risk prediction using discharge summaries (n = 500) produced an area under the receiver operating characteristic curve of 0.74 (Bag of Words + Neural Network). Thirty-day rehospitalization risk prediction using nursing notes (n = 2046) resulted in an area under the receiver operating characteristic curve of 0.85 (Bag of Words + Neural Network).

Conclusion

Nursing notes provide a superior input to risk models for 30-day rehospitalization in Medicare patients with HF compared with discharge summaries.
Predictors of COVID-19 Vaccine Uptake in Healthcare Workers
Authors: Galanis Petros , Moisoglou Ioannis , Vraka Irene , Siskou Olga , Konstantakopoulou Olympia , Katsiroumpa Aglaia , Kaitelidou Daphne
Published: December 2021

Objective:

We assessed the uptake of a COVID-19 vaccine and associated factors in a sample of healthcare workers (HCWs).

Methods:

An on-line cross-sectional study with 885 HCWs was conducted in Greece during August 2021. We measured socio-demographic data of HCWs and attitudes towards vaccination and the COVID-19 pandemic. A convenience sample was used since the questionnaire was distributed through social media and emails.

Results:

The majority of HCWs were vaccinated against the COVID-19 (91.5%). Females and HCWs with a history of seasonal influenza vaccination had a greater probability to get a COVID-19 vaccine. Also, increased self-perceived knowledge regarding the COVID-19 pandemic and increased trust in COVID-19 vaccines were associated with COVID-19 vaccine uptake.

Conclusions:

Policymakers and scientists should develop novel strategies to improve COVID-19 vaccine uptake among HCWs.
Pediatric screen time
Authors: McGough Kaitlyn
Published: December 2021

Background:

Ease of access to technology by the pediatric individual has brought with it new challenges for parents and guardians as they grapple to understand and formulate healthy boundaries between their child and the media. This transition into a media-forward generation has triggered a new wave of research discussing the relationship between early media exposure and the developing pediatric mind; media and the parent–child relationship; and recommendations for healthy boundaries from the American Academy of Pediatrics (AAP) as well as the American Academy of Child and Adolescent Psychiatry (AACAP) and American Psychological Association (APA).

Objectives:

This systematic review was written for the purposes of equipping physicians and nurse practitioners to be the bridge between research and their patients. Parents and guardians often do not have access to the same evidence-based resources as health care providers, and to be able to implement the latest recommendations in their home, they must first be introduced to them.

Data sources:

The search engines used were PubMed and CINAHL.

Conclusions:

Review of literature reveals the effect of socioeconomic status, parental education, and ethnicity on pediatric screen time habits. There are also clear positive and negative effects on the developing pediatric mind and undeniable influences on the parent–child relationship. To enhance patient outcomes, the AAP, the AACAP, and the APA have presented recommendations for healthy media use.

Implications for practice:

Early introduction of healthy media boundaries to the pediatric client will ultimately allow for the development of a physically, mentally, and socially healthier, more media-aware generation.
Temporal Stability of Dissociative Symptoms in the General Population
Authors: Maraldi Everton de Oliveira
Published: December 2021

The most widely used measure to quantify dissociative symptoms is the Dissociative Experiences Scale (DES). However, little information is available concerning its temporal stability. The purpose of this study was to assess the stability of DES scores after 4 years. A total of 316 respondents recruited from a general population in Brazil took part in baseline and follow-up (70.57% were men; mean age = 32.97, SD = 10.95, minimum = 22, maximum = 74). Temporal stability was assessed through test-retest correlations and mean-level stability analyses. We found that the DES total and subscale scores revealed moderate test-retest correlations, with small variations among the DES factors. No significant difference (p > 0.05) was found between average scores for times 1 and 2. Overall, DES scores are significantly stable over time. Future studies would benefit from an investigation of the correlates and predictors of dissociation at different time points.
Psychotic Experiences and Sleep Quality in the Emerging Adulthood
Authors: Lenzo Vittorio , Franceschini Christian , Manari Tommaso , Corsano Paola , Quattropani Maria C. , Musetti Alessandro
Published: December 2021

The present study investigated the integrated role of emotional neglect, bodily threat, and defense mechanisms in understanding sleep quality and psychosis experiences in a sample of emerging adults. A sample of 898 emerging adults (295 males) with an age range between 19 and 30 years participated in this study. The emotional neglect and bodily threat factors of the Traumatic Experiences Checklist, the Defense Style Questionnaire–40, the Pittsburgh Sleep Quality Index, and the psychosis factor of the Inventory of Personality Organization were administered. Results of path analyses showed that the emotional neglect and bodily threat factors predicted lower sleep quality. A path from emotional neglect and bodily threat to sleep quality via defense styles was also found. The defense styles mediated the relationships between emotional neglect and bodily threat factor with psychosis experiences. These findings provide new insight into the psychological mechanisms underlying the onset of poor sleep quality and psychotic experiences during emerging adulthood.
Anxiety, Depression, and Pain in the Perinatal Period: A Review for Obstetric Care Providers
Authors: Xiong Pa Ta , Poehlmann John , Stowe Zachary , Antony Kathleen M.
Published: December 2021

Importance

Maternal depression and anxiety may not only increase vulnerability for the development of postpartum depression and anxiety but may increase the perception of obstetric pain.

Objective

This review focuses on the relationship among depression, anxiety, and pain during pregnancy and postpartum. We will first review common clinical screening tools for depression, anxiety, and pain. Then, the existing evidence describing the relationship of depression, anxiety, and pain will be covered.

Evidence Acquisition

Queries for publications in PubMed, Google Scholar, and the CINAHL (Cumulative Index to Nursing and Allied Health Literature) were completed. Both searches were limited to publications within the last 20 years. Literatures on subtopics obtained from the references of publications identified in the initial search were not limited by publication year.

Results

A total of 19 total publications were identified regarding postpartum depression and pain; 17 were identified in the initial search, and 2 related to postpartum depression, anxiety, and pain were found by reviewing references. Eleven studies were identified regarding postpartum anxiety and pain; 4 were found in the original search, and 7 were identified by reviewing the references.

Conclusions and Relevance

The relationship between postpartum depression and pain is well characterized in the literature. However, the relationship between postpartum anxiety and pain is less well defined, and further research is needed. The interaction between maternal mental health and pain emphasizes the importance of screening for these conditions and also counseling and educating patients about expectations regarding intrapartum and postpartum pain.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

After participating in this activity, the reader should be better able to identify the high prevalence of anxiety and depression in the pregnant and postpartum population; describe the strengths and limitations of the existing tools to screen for depression, anxiety, and pain during pregnancy and the postpartum period; explain the existing literature describing the relationship between depression and pain during pregnancy and the postpartum period, and recommend interventions to reduce the amplifying effect of these 2 exposures; and summarize the limited existing literature describing the relationship between anxiety and pain during pregnancy and the postpartum period, with a goal of designing future interventions to reduce the effect of these 2 exposures.
Immediate “Kangaroo Mother Care” and Survival of Infants With Low Birth Weight
Authors:   WHO Immediate KMC Study Group
Published: December 2021

(Abstracted from N Engl J Med 2021;384:2028–2038)

Infants with low birth weight who are born preterm, are small for gestational age, or both make up a large percentage of all neonatal deaths worldwide. Addressing this disparity and reducing mortality among these infants are crucial to accomplishing the United Nations Sustainable Development Goals target of reducing neonatal mortality to 12 deaths per 1000 live births in all countries by the year 2030.
Avelumab Alone or in Combination With Chemotherapy Versus Chemotherapy Alone in Platinum-Resistant or Platinum-Refractory Ovarian Cancer (JAVELIN Ovarian 200): An Open-Label, Three-Arm, Randomised, Phase 3 Study
Authors: Pujade-Lauraine Eric , Fujiwara Keiichi , Ledermann Jonathan A. , Oza Amit M. , Kristeleit Rebecca , Ray-Coquard Isabelle-Laure , Richardson Gary E. , Sessa Cristiana , Yonemori Kan , Banerjee Susana , Leary Alexandra , Tinker Anna V. , Jung Kyung Hae , Madry Radoslaw , Park Sang-Yoon , Anderson Charles K. , Zohren Fabian , Stewart Ross A. , Wei Caimiao , Dychter Samuel S. , Monk Bradley J.
Published: December 2021

(Abstracted from Lancet Oncol 2021;22:1034–1046)

The majority of patients with ovarian cancer will experience relapse and develop platinum-resistant disease after being treated with frontline platinum-based chemotherapy. Treatment options for platinum-resistance or platinum-refractory disease are very limited, usually involving nonplatinum chemotherapy, and they are associated with poor objective response rates and life expectancy.
Impaired Fecundity as a Marker of Health and Survival: A Danish Twin Cohort Study
Authors: Ahrenfeldt L. J. , Möller S. , Wensink M. J. , Eisenberg M. L. , Christensen K. , Jensen T. K. , Lindahl-Jacobsen R.
Published: December 2021

(Abstracted from Hum Reprod 2021;36:2309–2320)

Time to pregnancy (TTP), defined as the interval of time between a couple beginning to practice unprotected intercourse and conception, is a measure of fecundity, which is an individual's biologic capacity to reproduce. Fecundity has reportedly decreased over recent decades for unknown reasons that may include lifestyle, behavioral, and environmental factors.
The Combined Use of Endometrial Ablation or Resection and Levonorgestrel-Releasing Intrauterine System in Women With Heavy Menstrual Bleeding: A Systematic Review
Authors: Oderkerk Tamara J. , van de Kar Majorie M. A. , van der Zanden Carlijn H. M. , Geomini Peggy M. A. J. , Herman Malou C. , Bongers Marlies Y.
Published: December 2021

(Abstracted from Acta Obstet Gynecol Scand 2021;100:1779–1787)

Heavy menstrual bleeding (HMB) affects approximately 10% to 30% of women of reproductive age and is often treated conservatively with insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) or endometrial ablation/resection (EA). The LNG-IUS induces atrophy of endometrial tissue, whereas EA is a minimally invasive, uterus-preserving procedure that destroys endometrial tissue and superficial myometrium.
Loss of Nuclear Basophilic Staining as a Postmortem Interval Marker
Authors: Alabbasi Samah F. , Viramontes Ariel C. , Diaz Francisco J. , Weedn Victor W.
Published: December 2021

Introduction

The loss of basophilia (LOB), as an objective marker of postmortem interval (PMI), was evaluated. Such a correlation has been previously reported in stillborn fetuses.

Method

Loss of basophilia in different tissues was scored using hematoxylin and eosin-stained slides obtained from 65 random autopsy cases. Scatter plots were used to visually assess the correlation of PMI with our LOB scores. Decomposition was assessed using a modified total body score.

Results

Loss of basophilia was found to be correlated with PMI (total and unrefrigerated intervals). Specifically in this study, we found full or partial basophilic staining up to 26 hours after death, and complete LOB was seen in cases as early as 36 hours in liver and 60 hours in heart. Loss of basophilia also well correlated with the modified total body score. The LOB varied by tissue and was uncorrelated to histologically observable bacteria and fungi. Refrigeration appeared to stop the autolytic process that causes the LOB.

Conclusion

Complete LOB can be expected between 1 and 2 days after death in unrefrigerated liver and heart tissues because of autolysis.