bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Early Postoperative T1 Slope Change Affect Clinical Results of Patients With Single-level ACDF?
Authors: Guo Yingjun , Liu Hao , Meng Yang , Wang Xiaofei , Yang Yi , Ding Chen , Wang Beiyu
Published: April 2021

Study Design:

This was a retrospective study.

Objective:

The main question of this study is whether the change of postoperative T1 slope will affect the clinical and imaging recovery of patients with single-level anterior cervical discectomy and fusion (ACDF).

Summary of Background Data:

The T1 slope after ACDF is different from that preoperatively, however, the clinical significance of this change has not been reported.

Materials and Methods:

A retrospective analysis was conducted on 87 patients with single-level ACDF. Visual Analogue Scale was used to compare neck and upper limb pain before and after surgery. Neurological improvement was assessed by the Japanese Orthopaedic Association Scores and Neck Disability Index. Preoperative and postoperative T1 slope, occipital-C2 angle, C2–C7 overall curvature and functional spinal unit curvature were measured and analyzed by lateral cervical spine x-ray.

Results:

All patients were followed up for 23.98±12.17 months. The Japanese Orthopaedic Association, Visual Analogue Scale, and Neck Disability Index scores as well as the overall curvature and change of C2–C7 and functional spinal unit were significantly improved in the last postoperative follow-up. At 12 months after surgery and the last follow-up, patients with increased T1 slope had more severe neck pain symptoms than those with decreased T1 slope (P<0.05). The overall curvature and change of C2–C7 in patients with increased T1 slope were better than those with decreased T1 slope (P<0.05).

Conclusion:

For patients with increased postoperative T1 slope after single-level ACDF, the degree of postoperative neck pain was more severe, suggesting that some clinical intervention is needed.
Vandetanib-eluting radiopaque beads for chemoembolization: physicochemical evaluation and biological activity of vandetanib in hypoxia
Authors: Hagan Alice E. , Znati Sami A. , Carter Rebecca , Westhorpe Adam , Macfarlane Wendy M. , Phillips Gary J. , Lloyd Andrew W. , Sharma Ricky A. , Lewis Andrew L.
Published: April 2021

Vandetanib-eluting radiopaque beads (VERB) have been developed for use in transarterial chemoembolization of liver tumours, with the goal of combining embolization with local delivery of antiangiogenic therapy. The objective of this study was to investigate how embolization-induced hypoxia may affect antitumoural activity of vandetanib, an inhibitor of vascular endothelial growth factor receptor (VEGFR) and epidermal growth factor receptor (EGFR), in the context of hepatocellular carcinoma (HCC) treatment. We studied the effect of vandetanib on proliferation, cell cycle and apoptosis of HCC cells, in hypoxic conditions, as well as the direct effects of the beads on 3D HCC spheroids. Vandetanib suppressed proliferation and induced apoptosis of HCC cells in vitro and was equipotent in hypoxic and normoxic conditions. High degrees of apoptosis were observed among cell lines in which vandetanib suppressed ERK1/2 phosphorylation and upregulated the proapoptotic protein Bim, but this did not appear essential for vandetanib-induced cell death in all cell lines. Vandetanib also suppressed the hypoxia-induced secretion of VEGF from HCC cells and inhibited proliferation of endothelial cells. Incubation of tumour spheroids with VERB led to sustained growth inhibition equivalent to the effect of free drug. We conclude that vandetanib has both antiangiogenic and direct anticancer activity against HCC cells even in hypoxic conditions, warranting the further evaluation of VERB as novel anticancer agents.
CircRASSF2 facilitates the proliferation and metastasis of colorectal cancer by mediating the activity of Wnt/β-catenin signaling pathway by regulating the miR-195-5p/FZD4 axis
Authors: Yang Leilei , Bi Tienan , Zhou Shenkang , Lan Yuefu , Zhang Ruili
Published: April 2021

Circular RNAs (circRNA) are a key regulator of cancer progression, including colorectal cancer (CRC). Nevertheless, the role of circRASSF2 in CRC remains unclear. Quantitative real-time PCR was used to measure the expression of circRASSF2 and miR-195-5p. Cell counting kit 8 assay, colony formation assay, flow cytometry and transwell assay were used to determine the proliferation, apoptosis, migration and invasion of cells, respectively. The levels of proliferation, metastasis and Wnt/β-catenin signaling pathway-related proteins, as well as Frizzled 4 (FZD4) protein, were determined using western blot analysis. Furthermore, a dual-luciferase reporter assay, RNA immunoprecipitation assay and RNA pull-down assay were used to illumine the mechanism of circRASSF2. Animal experiments were used to determine the role of circRASSF2 in the tumor growth of CRC in vivo. Our study reported that circRASSF2 was upregulated in CRC tissues and cells, and its high expression was related to the poor prognosis of CRC patients. CircRASSF2 knockdown could inhibit proliferation, migration, invasion, and enhance apoptosis in CRC cells, and its overexpression had the opposite effect. Besides, our data revealed that circRASSF2 could sponge miR-195-5p, and miR-195-5p could target FZD4. The rescue experiments indicated that both miR-195-5p inhibitor and FZD4 overexpression could reverse the negative regulation of circRASSF2 silencing on CRC progression. Moreover, circRASSF2 could positively regulate the activity of Wnt/β-catenin signaling pathway by the miR-195-5p/FZD4 axis. In addition, circRASSF2 knockdown restrained the tumor growth of CRC in vivo. Our findings suggested that circRASSF2 might function as a tumor promoter to accelerate the progression of CRC via regulating the miR-195-5p/FZD4/Wnt/β-catenin pathway.
Cumulative Application of Creatinine and Urine Output Staging Optimizes the Kidney Disease: Improving Global Outcomes Definition and Identifies Increased Mortality Risk in Hospitalized Patients With Acute Kidney Injury
Authors: Sutherland Scott M. , Kaddourah Ahmad , Gillespie Scott E. , Soranno Danielle E. , Woroniecki Robert P. , Basu Rajit K. , Zappitelli Michael
Published: April 2021

OBJECTIVES:

Acute kidney injury is diagnosed according to creatinine and urine output criteria. Traditionally, both are applied, and a severity stage (1–3) is conferred based upon the more severe of the two; information from the other criteria is discarded. Physiologically, however, rising creatinine and oliguria represent two distinct types of renal dysfunction. We hypothesized that using the information from both criteria would more accurately characterize acute kidney injury severity and outcomes.

DESIGN:

Prospective cohort study.

SETTING:

Multicenter, international collaborative of ICUs.

PATIENTS:

Three thousand four hundred twenty-nine children and young adults admitted consecutively to ICUs as part of the Assessment of the Worldwide Acute Kidney Injury, Renal Angina and Epidemiology Study.

MEASUREMENTS AND MAIN RESULTS:

The Kidney Disease: Improving Global Outcomes creatinine and urine output acute kidney injury criteria were applied sequentially, and the two stages were summed, generating an Acute Kidney Injury (AKI) Score ranging from 1 to 6. The primary outcome was 28-day mortality; secondary outcomes were time until ICU discharge and nonrecovery from acute kidney injury. Models considered associations with AKI Score, assessing the relationship unadjusted and adjusted for covariates. Twenty-eight–day mortality and nonrecovery from acute kidney injury were modeled using logistic regression. For 28-day ICU discharge, competing risks analysis was performed. Although AKI Scores 1–3 had similar mortality to no Acute Kidney Injury, AKI Scores 4–6 were associated with increased mortality. Relative to No Acute Kidney Injury, AKI Scores 1–6 were less likely to be discharged from the ICU within 28 days. Relative to AKI Score 1, AKI Scores 2–6 were associated with higher risk of nonrecovery. Within the traditional Kidney Disease: Improving Global Outcomes Stage 3 acute kidney injury cohort, when compared with AKI Score 3, AKI Scores 4–6 had increased mortality, AKI Scores 5–6 had prolonged time to ICU discharge, and AKI Score 6 experienced higher nonrecovery rates.

CONCLUSIONS:

Cumulative application of the creatinine and urine output criteria characterizes renal excretory and fluid homeostatic dysfunction simultaneously. This Acute Kidney Injury score more comprehensively describes the outcome implications of severe acute kidney injury than traditional staging methods.
Development, Application, and Effectiveness of a Smart Device-based Nursing Competency Evaluation Test
Authors: Jang Soyoung , Suh Eunyoung E.
Published: May 2021

We aimed to develop and evaluate the effectiveness of a smart device–based test to assess Korean undergraduate students' clinical nursing competency, named SBT-NURS. The 65-item SBT-NURS comprises questions that simulate clinical situations, are problem solving–oriented, use multimedia (ie, videos/photos/animations), and involve the following topics: medical-surgical nursing, fundamentals of nursing, pediatrics, maternity, management, and psychiatric. We utilized a quantitative method to analyze the effects of the SBT-NURS (ie, via a single-group, post-experimental survey design) and a qualitative method to analyze students' experiences of using the SBT-NURS (ie, via seven focus group interviews [FGIs]). Students' overall adult health nursing paper-based test scores (ie, combining their scores in group activity, presentation, attendance, and attitude toward the midterm and final tests on adult health nursing) (r = 0.552, P < .001) and clinical practicum scores (r = 0.268, P = .040) in the last semester showed a statistically significant positive correlation with their SBT-NURS scores. Their paper-based testing practice average scores (ie, combination between paper-based tests and clinical practicum scores) showed a similar significant correlation (r = 0.506, P < .001). Students deemed the SBT-NURS advantageous, satisfactory, convenient, and useful. The SBT-NURS may be an effective learning and evaluation method for nursing education that help improve students' clinical competency and learning outcomes.
Virtual Simulation in Undergraduate Nursing Education
Authors: Liu Wei
Published: May 2021

Virtual simulation as an emerging nursing pedagogy can facilitate optimal learning through the use of experiential learning and technology. The purpose of this prospective cohort study was to assess the long-term effects of virtual simulation on undergraduate nursing students' recognition of and causative beliefs about depression and schizophrenia. Students' responses from the simulation cohort (n = 149) and the nonsimulation cohort (n = 150) at a school of nursing in the United States were compared. While students' responses were fairly similar between the two cohorts, students who received virtual simulations more often rated character weakness as an unlikely cause for schizophrenia than those who did not receive virtual simulations. The major difference supports the use of virtual simulation in influencing positive changes in nursing students' perceptions and attitudes toward mental illness.
Statistical, Clinical, Methodological Evaluation of Local Recurrence Following Transanal Total Mesorectal Excision for Rectal Cancer: A Systematic Review
Authors: Wasmuth Hans H. , Gachabayov Mahir , Bokey Les , Fingerhut Abe , Orangio Guy R. , Remzi Feza H. , Bergamaschi Roberto
Published: May 2021

BACKGROUND:

A recent Norwegian moratorium challenged the status quo of transanal total mesorectal excision for rectal cancer by reporting increased early multifocal local recurrences.

OBJECTIVE:

The aim of this systematic review and meta-analysis was to evaluate the local recurrence rates following transanal total mesorectal excision as well as to assess statistical, clinical, and methodological bias in reports published to date.

DATA SOURCES:

The PubMed and MEDLINE (via Ovid) databases were systematically searched.

STUDY SELECTION:

Descriptive or comparative studies reporting rates of local recurrence at a median follow-up of 6 months (or more) after transanal total mesorectal excision were included.

INTERVENTIONS:

Patients underwent transanal total mesorectal excision.

MAIN OUTCOME MEASURES:

Local recurrence was any recurrence located in the pelvic surgery site. The untransformed proportion method of 1-arm meta-analysis was utilized. Untransformed percent proportion with 95% confidence interval was reported. Ad hoc meta-regression with the Omnibus test was utilized to assess risk factors for local recurrence. Among-study heterogeneity was evaluated: statistically by I
2 and τ2, clinically by summary tables, and methodologically by a 33-item questionnaire.

RESULTS:

Twenty-nine studies totaling 2906 patients were included. The pooled rate of local recurrence was 3.4% (2.7%–4.0%) at an average of 20.1 months with low statistical heterogeneity (I
2 = 0%). Meta-regression yielded no correlation between complete total mesorectal excision quality (p = 0.855), circumferential resection margin (p = 0.268), distal margin (p = 0.886), and local recurrence rates. Clinical heterogeneity was substantial. Methodological heterogeneity was linked to the excitement of novelty, loss aversion, reactivity to criticism, indication for transanal total mesorectal excision, nonprobability sampling, circular reasoning, misclassification, inadequate follow-up, reporting bias, conflict of interest, and self-licensing.

LIMITATIONS:

The studies included had an observational design and limited sample and follow-up.

CONCLUSION:

This systematic review found a pooled rate of local recurrence of 3.4% at 20 months. However, given the substantial clinical and methodological heterogeneity across the studies, the evidence for or against transanal total mesorectal excision is inconclusive at this time.
An Aggregated Comorbidity Measure Based on History of Filled Drug Prescriptions: Development and Evaluation in Two Separate Cohorts
Authors: Gedeborg Rolf , Sund Malin , Lambe Mats , Plym Anna , Fredriksson Irma , Syrjä Johan , Holmberg Lars , Robinson David , Stattin Pär , Garmo Hans
Published: May 2021

Background:

The ability to account for comorbidity when estimating survival in a population diagnosed with cancer could be improved by using a drug comorbidity index based on filled drug prescriptions.

Methods:

We created a drug comorbidity index from age-stratified univariable associations between filled drug prescriptions and time to death in 326,450 control males randomly selected from the general population to men with prostate cancer. We also evaluated the index in 272,214 control females randomly selected from the general population to women with breast cancer.

Results:

The new drug comorbidity index predicted survival better than the Charlson Comorbidity Index (CCI) and a previously published prescription index during 11 years of follow-up. The concordance (C)-index for the new index was 0.73 in male and 0.76 in the female population, as compared with a C-index of 0.67 in men and 0.69 in women for the CCI. In men of age 75–84 years with CCI = 0, the median survival time was 7.1 years (95% confidence interval [CI] = 7.0, 7.3) in the highest index quartile. Comparing the highest to the lowest drug comorbidity index quartile resulted in a hazard ratio (HR) of 2.2 among men (95% CI = 2.1, 2.3) and 2.4 among women (95% CI = 2.3, 2.6).

Conclusions:

A new drug comorbidity index based on filled drug prescriptions improved prediction of survival beyond age and the CCI alone. The index will allow a more accurate baseline estimation of expected survival for comparing treatment outcomes and evaluating treatment guidelines in populations of people with cancer.
Metformin Attenuates Hypoxia-induced Endothelial Cell Injury by Activating the AMP-Activated Protein Kinase Pathway
Authors: Hu Jinxing , Zheng Zeqi , Li Xuelian , Li Bingong , Lai Xingjun , Li Na , Lei Shufang
Published: April 2021

Metformin reduces the incidence of cardiovascular diseases, and potential underlying mechanisms of action have been suggested. Here, we investigated the role of metformin in endothelial cell injury and endothelial–mesenchymal transition (EndMT) induced by hypoxia. All experiments were performed in human cardiac microvascular endothelial cells (HCMECs). HCMECs were exposed to hypoxic conditions for 24, 48, 72, and 96 hours, and we assessed the cell viability by cell counting kit 8; metformin (2, 5, 10, and 20 mmol/L) was added to the cells after exposure to the hypoxic conditions for 48 hours. The cells were randomly divided into the control group, hypoxia group, hypoxia + metformin group, hypoxia + control small interfering RNA group, hypoxia + small interfering Prkaa1 (siPrkaa1) group, and hypoxia + siPrkaa1 + metformin group. Flow cytometry and cell counting kit 8 were used to monitor apoptosis and assess cell viability. Immunofluorescence staining was used to identify the CD31+/alpha smooth muscle actin+ double-positive cells. Quantitative real-time-PCR and Western blot were used for mRNA and protein expression analyses, respectively. Hypoxia contributed to endothelial injuries and EndMT of HCMECs in a time-dependent manner, which was mainly manifested as decreases in cell viability, increases in apoptotic rate, and changes in expression of apoptosis-related and EndMT-related mRNAs and proteins. Furthermore, metformin could attenuate the injuries and EndMT caused by hypoxia. After metformin treatment, phosphorylated-AMPK (pAMPK) and p-endothelial nitric oxide synthase expression increased, whereas p-mammalian target of rapamycin expression decreased. However, results obtained after transfection with siPrkaa1 were in contrast to the results of metformin treatment. In conclusion, metformin can attenuate endothelial injuries and suppress EndMT of HCMECs under hypoxic conditions because of its ability to activate the AMPK pathway, increase p-AMPK/AMP-activated protein kinase, and inhibit mammalian target of rapamycin.
Assessing Differences in Concussion Symptom Knowledge and Sources of Information Among Black and White Collegiate-Athletes
Authors: Wallace Jessica , Beidler Erica , Kerr Zachary Y. , Hibbler Tamaria , Anderson Morgan , Register-Mihalik Johna K.
Published: May 2021

Objective:

Basic concussion symptom knowledge is fundamental to concussion identification; however, racial disparities in concussion knowledge exist in high school and youth sports. It is unknown whether similar differences exist in collegiate-athletes. Identifying racial disparities in concussion knowledge and sources of concussion information is essential to inform equitable approaches to knowledge translation and educational interventions. This study examined how Black and White collegiate-athletes differed in their knowledge of concussion symptoms and use of concussion information sources.

Setting:

National Collegiate Athletic Association (NCAA) institutions.

Participants:

Collegiate-athletes.

Design:

Cross-sectional.

Main Measures:

Collegiate-athletes completed a questionnaire that assessed personal and sports demographics, concussion symptom knowledge, and use of concussion information sources. Fisher's exact tests and Wilcoxon rank-sum tests examined differences in outcome measures between Black and White collegiate-athletes. A multivariable Poisson regression model examined the association between race and concussion symptom knowledge scores while accounting for sex, sports contact level, NCAA division, concussion history, and specific concussion information sources. Incidence rate ratios (IRRs) with 95% CIs excluding 1.00 were deemed significant.

Results:

A total of 768 (82.6% White, 17.4% Black) collegiate-athletes completed the questionnaire. Black athletes were more likely to have lower concussion symptom knowledge scores than White athletes (P < .001). In the multivariable Poisson regression model controlling for covariates, this finding was retained (IRR = 0.97; 95% CI, 0.94-0.997). White athletes were more likely to report school-based professional (P < .001), online medical sources (P = .02), and the NCAA (P = .008) as sources of concussion information. Black athletes were more likely to report referees (P = .03) as a source of concussion knowledge.

Conclusion:

Despite NCAA concussion education requirements for athletes, Black collegiate-athletes were found to have lower concussion knowledge than White collegiate-athletes. The findings highlight the need for equitable strategies to disseminate concussion information to diverse populations by improving the physician-patient relationship and investing in culturally appropriate educational materials.
Outcomes of Human Leukocyte Antigen–Matched Allogeneic Cultivated Limbal Epithelial Transplantation in Aniridia-Associated Keratopathy—A Single-Center Retrospective Analysis
Authors: Behaegel Joséphine , Tassignon Marie-José , Lagali Neil , Consejo Alejandra , Koppen Carina , Ní Dhubhghaill Sorcha
Published: April 2021

Purpose:

To assess the efficacy and safety of human leukocyte antigen–matched allogeneic cultivated limbal epithelial stem cell grafts in the treatment of aniridia-associated keratopathy (AAK).

Methods:

Six eyes of 6 patients with severe AAK received an allogeneic stem cell graft between January 2010 and March 2017. Anatomical and functional results were assessed at 6 months, 1 year, 2 years, and the final follow-up visit available. Safety analysis was performed by considering all perioperative and postoperative adverse events and additional surgeries required during the follow-up period.

Results:

The mean follow-up was 53.6 months (range 24–104 months). In most patients (80%), there was an early improvement of the keratopathy postoperatively, which slowly regressed during longer follow-up. At the final follow-up, 4 of the eyes were graded as failure and 1 eye was graded as partial success. Grading the sixth eye was not possible because of an adverse event. None of the patients maintained a total anatomical success in the long-term. Only 1 patient maintained a modest improvement in best-corrected visual acuity from hand motion to counting fingers. Four serious adverse events were recorded in 2 patients.

Conclusions:

Severe AAK remains a challenging condition to manage. Transplantation of allogenic ex vivo cultivated limbal stem cells may provide a temporary improvement in ocular surface stability, but anatomical and functional results are poor in the long-term. The eyes are prone to adverse events, and any surgical treatment should take this into consideration.
Clinical Outcomes and Patient Satisfaction After Corneal Neurotization
Authors: Rafailov Leon , Kim Jane S. , Wisely Clayton Ellis , Espana Edgar M. , Soifer Matias , Leyngold Ilya M.
Published: April 2021

Purpose:

The aim of this study was to assess clinical outcomes of corneal neurotization (CN) and determine patient perception of postoperative results.

Methods:

This was a retrospective study involving 29 eyes in 28 patients who underwent CN. Chart review data included demographic and clinical history; ophthalmic examination including visual acuity, ocular surface quality, and corneal sensation; surgical technique; and postoperative course. Subjective self-reported patient outcomes of surgical success were also assessed. Only eyes with at least 6 months of follow-up were included in the statistical analysis.

Results:

A total of 24 eyes and 23 patients were included in statistical analyses. The median postoperative follow-up time was 12.2 months (interquartile range 10.9–18.5 mo). Twenty-three eyes (92%) achieved improvement in ocular surface quality. Eleven of 13 (85%) demonstrated healing of persistent epithelial defects at their last follow-up. Patients gained a median of 2.3 cm in Cochet–Bonnet esthesiometry measurements of sensation. No significant difference was found between preoperative and postoperative visual acuity. All 17 patients who provided self-assessment of their surgical outcome indicated they would undergo CN again if given the choice. Most of the patients reported that the postoperative pain was tolerable, with a median pain score of 3.0 on a 10-point scale (interquartile range 0.0–4.0). Sixteen patients (94%) reported full or partial return of skin sensation along the donor nerve distribution.

Conclusions:

CN provides improvement in corneal health and sensibility, with high patient satisfaction and minimal postoperative pain and morbidity.
Optical Coherence Tomography Angiography Vessel Density Changes in Normal-tension Glaucoma Treated With Carteolol, Brimonidine, or Dorzolamide
Authors: Lin Yun-Hsuan , Su Wei-Wen , Huang Shih-Ming , Chuang Lan-Hsin , Chen Lung-Chien
Published: April 2021

Precis:

In patients with normal-tension glaucoma (NTG), topical dorzolamide might enhance the vessel density (VD), topical carteolol decreased the VD in the inferior-temporal peripapillary retina, whereas topical brimonidine did not change the VD.

Purpose:

Topical antiglaucoma medications may improve ocular perfusion pressure or microcirculation in the optic nerve head. The study evaluated responses of retinal VD to topical carteolol, brimonidine, and dorzolamide in NTG using optical coherence tomography angiography.

Patients and Methods:

This is a retrospective, nonrandomized, comparative study. The study included 131 individuals (77 men, 54 women) diagnosed with NTG, without systemic medication use, who visited the glaucoma clinic of Chang Gung Memorial Hospital, Taiwan, between January 2019 and May 2020. If both eyes were diagnosed with NTG, only the right eye was included. Of these, there were 80 carteolol-treated eyes, 27 brimonidine-treated eyes, and 24 dorzolamide-treated eyes. We studied the response of optical coherence tomography angiography parameters and retinal nerve fiber layer (RNFL) thickness to drugs, 6 months after treatment.

Results:

In dorzolamide-treated eyes, increases in the peripapillary superficial retinal VD, especially in the superior-nasal area, were significant; however, no RNFL thickness changes were observed. In contrast, the superficial retinal VD decreased at the inferior-temporal peripapillary area, and RNFL thickness decreased in the inferior-nasal peripapillary area of carteolol-treated eyes. Finally, in brimonidine-treated eyes, changes in either VD parameters or RNFL thickness were not significant.

Conclusions:

Topical dorzolamide possibly enhanced the VD of the peripapillary retina in NTG eyes. On the contrary, topical carteolol possibly decreased VD in the inferior-temporal peripapillary retina. Finally, in cases treated with topical brimonidine, peripapillary microcirculation remained unchanged. The study shows preliminary results and future large-scale studies are needed to confirm findings.
Bilateral Acute Angle Closure Glaucoma After Prone Position Ventilation for COVID-19 Pneumonia
Authors: Nerlikar Roopali R. , Palsule Aratee C. , Vadke Shantanu
Published: April 2021

We report a case of bilateral acute angle closure glaucoma developing after prone position ventilation for severe COVID-19 pneumonia. A 53-year-old diabetic and hypertensive male developed blurred vision and ocular discomfort in both eyes after prone position ventilation for severe COVID-19 pneumonia. At initial examination he was noted to have diffuse corneal edema with shallow anterior chambers and mid dilated non reacting pupils. His intraocular pressure was 48 and 54 mm Hg in right and left eye, respectively. Following intravenous mannitol (20%) infusion, oral acetazolamide 250 mg 3 times daily, along with topical therapy with combination Brimonidine and Brinzolamide eye drops and Fluoromethalone eye drops his corneal edema resolved and subsequent to laser iridotomy his intraocular pressures lowered significantly and could be maintained below 16 mm Hg in both eyes with topical therapy alone. With prone position ventilation being a commonly used adjuvant treatment for acute respiratory distress syndrome associated with COVID-19 pneumonia, acute angle closure may be precipitated in these patients if they have pre-existing narrow angles. Awareness of the possibility and its recognition may allow prompt ophthalmic referral, early treatment and minimize visual consequences.
New Advances in Physician Assistant Admissions: The History of Situational Judgement Tests and the Development of CASPer
Authors: Buchs Shalon R. , McDaniel M. Jane
Published: May 2021

During the first 50 years of the physician assistant (PA) profession, admission to PA programs was based primarily on cognitive domains such as academic performance and standardized test scores. Many programs also considered other measurable factors, including patient care experience, community service, and extracurricular activities. While interviews were frequently conducted by the programs, it was not until the applicants had been “pre-screened” for the previously identified qualifications. As the PA profession continued to expand, PA programs began to realize that potentially strong applicants were being excluded from the admissions process because of this emphasis on mostly cognitive factors. In an attempt to reduce this disparity, PA programs have begun to expand their assessment of applicants to include assessment of noncognitive characteristics. This article outlines the history surrounding this change in the approach to admissions in medical education, reviews the development of situational judgement tests and other tools used to assess these noncognitive characteristics, and explores the relationship of these noncognitive characteristics to the development of program-defined competencies.
Purine metabolites and complex diseases: role of genes and nutrients
Authors: Nelson Kendra L. , Voruganti Venkata Saroja
Published: April 2021

Purpose of review

Purines have several important physiological functions as part of nucleic acids and as intracellular and extracellular signaling molecules. Purine metabolites, particularly uric acid, have been implicated in congenital and complex diseases. However, their role in complex diseases is not clear and they have both beneficial and detrimental effects on disease pathogenesis. In addition, the relationship between purines and complex diseases is affected by genetic and nutritional factors. This review presents latest findings about the relationship between purines and complex diseases and the effect of genes and nutrients on this relationship.

Recent findings

Evidence from recent studies show strong role of purines in complex diseases. Although they are causal in only few diseases, our knowledge about their role in other diseases is still evolving. Of all the purines, uric acid is the most studied. Uric acid acts as an antioxidant as well as a prooxidant under different conditions, thus, its role in disease also varies. Other purines, adenosine and inosine have been less studied, but they have neuroprotective properties which are valuable in neurodegenerative diseases.

Purines are molecules with great potential in disease pathogenesis as either metabolic markers or therapeutic targets. More studies need to be conducted to understand their relevance for complex diseases.
Provider Perceptions of Virtual Care During the Coronavirus Disease 2019 Pandemic
Authors: Connolly Samantha L. , Gifford Allen L. , Miller Christopher J. , Bauer Mark S. , Lehmann Lisa S. , Charness Michael E.
Published: April 2021

Background:

The coronavirus disease 2019 (COVID-19) pandemic has led to a dramatic increase in virtual care (VC) across outpatient specialties, but little is known regarding provider acceptance of VC.

Objective:

The objective of this study was to assess provider perceptions of the quality, efficiency, and challenges of VC versus in-person care with masks.

Design:

This was a voluntary survey.

Participants:

Mental health (MH), primary care, medical specialty, and surgical specialty providers across the 8 VA New England Healthcare System medical centers.

Measures:

Provider ratings of: (1) quality and efficiency of VC (phone and video telehealth) compared with in-person care with masks; (2) challenges of VC; and (3) percentage of patients that providers are comfortable seeing via VC in the future.

Results:

The sample included 998 respondents (49.8% MH, 20.6% primary care, 20.4% medical specialty, 9.1% surgical specialty; 61% response rate). Most providers rated VC as equivalent to or higher in quality and efficiency compared with in-person care with masks. Quality ratings were significantly higher for video versus phone (χ2=61.4, P<0.0001), but efficiency ratings did not differ significantly. Ratings varied across specialties (highest in MH, lowest in SS; all χ2s>24.1, Ps<0.001). Inability to conduct a physical examination and patient technical difficulties were significant challenges. MH providers were comfortable seeing a larger proportion of patients virtually compared with the other specialties (all χ2s>12.2, Ps<0.01).

Conclusions:

Broad provider support for VC was stratified across specialties, with the highest ratings in MH and lowest ratings in SS. Findings will inform the improvement of VC processes and the planning of health care delivery during the COVID-19 pandemic and beyond.
18F-FDG PET/computed tomography scan in patients with suspicion of recurrent neuroendocrine carcinoma of the cervix
Authors: Jiang Yuanyuan , Hou Guozhu , Huo Li , Li Fang , Zhu Zhaohui , Cheng Wuying
Published: April 2021

Objectives

The aim of this study was to investigate the value of [18F]fluoro-2-deoxy-D-glucose (18F-FDG) PET/computed tomography (CT) to detect recurrent cervical neuroendocrine carcinoma and its subsequent impact on patient management.

Methods

A total of 25 patients who had undergone 30 18F-FDG PET/CT studies for suspected recurrent cervical neuroendocrine carcinoma (18 small cells, 2 large cells, 1 atypical carcinoid, and 4 unclassified) were retrospectively analyzed. The findings of the PET/CT images were compared with the histopathologic results in 8 scans and with clinical follow-up in 22 scans.

Results

Of the 30 PET/CT studies, 63.3% (19/30) were positive for recurrence while 36.7% (11/30) were negative. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 18F-FDG PET/CT for detecting recurrent disease of cervical neuroendocrine carcinomas were 90.0, 90.0, 94.7, 81.8, and 90.0%, respectively. Metastasis to distant organs was the most common (89.4%), followed by lymph node recurrence (52.6%). Lungs were the most frequent site of distant metastasis (63.1%). 18F-FDG PET/CT findings led to the change of the management in 10 out of 25 patients (40%) by introducing the use of previously unplanned therapeutic procedures.

Conclusions

18F-FDG PET/CT is an efficient technique for detecting recurrent cervical neuroendocrine carcinoma, and may thus contribute to improving patient management.
Testing for and identification of Multisystem Inflammatory Syndrome in children in the pediatric emergency department
Authors: Patel Roshni , Patel Katie J. , Rocker Joshua
Published: April 2021

Purpose of review

The current article summarizes updates on multisystem inflammatory syndrome in children (MIS-C) research and focuses on strategies to diagnose and manage these patients in the emergency department.

Recent findings

MIS-C is an inflammatory syndrome that occurs approximately 4-5 weeks after severe acute respiratory syndrome coronavirus 2 infection. It is associated with symptoms such as fever, shock, abdominal pain, rash, and conjunctivitis along with laboratory abnormalities such as elevated inflammatory markers, coagulation factors, and cytokines. Patients fall into the following three subcategories: first, classic or incomplete Kawasaki; second, cardiogenic or distributive shock; or third, an inflammatory response that does not initially meet criteria of the other subcategories. Immediate treatment largely focuses on supportive care through fluid resuscitation and pressor support; however, inpatient management may also include intravenous immunoglobulin, steroids, anticoagulation and at times anti-inflammatory biologics.

Overall fatality rate remains low and short-term research has demonstrated self-limited sequelae. Pediatricians should focus on the timely diagnosis and identification of this inflammatory disease via clinical findings and laboratory evidence to best treat these patients.
Future artificial intelligence tools and perspectives in medicine
Authors: Chaddad Ahmad , Katib Yousef , Hassan Lama
Published: April 2021

Purpose of review

Artificial intelligence has become popular in medical applications, specifically as a clinical support tool for computer-aided diagnosis. These tools are typically employed on medical data (i.e., image, molecular data, clinical variables, etc.) and used the statistical and machine-learning methods to measure the model performance. In this review, we summarized and discussed the most recent radiomic pipeline used for clinical analysis.

Recent findings

Currently, limited management of cancers benefits from artificial intelligence, mostly related to a computer-aided diagnosis that avoids a biopsy analysis that presents additional risks and costs. Most artificial intelligence tools are based on imaging features, known as radiomic analysis that can be refined into predictive models in noninvasively acquired imaging data. This review explores the progress of artificial intelligence-based radiomic tools for clinical applications with a brief description of necessary technical steps. Explaining new radiomic approaches based on deep-learning techniques will explain how the new radiomic models (deep radiomic analysis) can benefit from deep convolutional neural networks and be applied on limited data sets.

To consider the radiomic algorithms, further investigations are recommended to involve deep learning in radiomic models with additional validation steps on various cancer types.
High-Grade Gastroenteropancreatic Neuroendocrine Neoplasms and Improved Prognostic Stratification With the New World Health Organization 2019 Classification
Authors: Hayes Aimee R. , Furnace Myles , Shah Ruchir , Rundell Caroline , Muller Gregory , Dehbi Hakim-Moulay , Luong Tu Vinh , Toumpanakis Christos , Caplin Martyn E. , Krell Daniel , Thirlwell Christina , Mandair Dalvinder
Published: May 2021

Objectives

There is a pressing need to develop clinical management pathways for grade 3 (G3) gastroenteropancreatic neuroendocrine neoplasms (GEP NEN).

Methods

We performed a retrospective study on patients with metastatic G3 GEP NEN. The relationship between baseline characteristics and progression-free survival and overall survival was analyzed using the Kaplan-Meier method. Univariate and multivariate analyses were performed using the Cox proportional hazards model.

Results

We included 142 patients (74 well-differentiated neuroendocrine tumors [WDNETs], 68 poorly differentiated neuroendocrine carcinomas [PDNECs]). Patients with WDNET had prolonged survival compared with PDNEC (median, 24 vs 15 months, P = 0.0001), which persisted in both pancreatic and nonpancreatic cohorts. Well-differentiated morphology, Ki-67 <50% and positive somatostatin receptor imaging were independently associated with prolonged survival. Of the subgroup treated with first-line platinum-based chemotherapy, response rates were favorable (partial response, 47%; stable disease, 30%); there was no significant difference in response rates nor progression-free survival between WDNET and PDNEC despite significantly prolonged overall survival in the WDNET cohort.

Conclusions

Our study corroborates the knowledge of 2 prognostically distinct subgroups within the World Health Organization 2019 G3 GEP NEN population, observed in both pancreatic and nonpancreatic gastrointestinal cohorts. Definitive management pathways are needed to reflect the differences between G3 WDNET and PDNEC.
Esophagitis Dissecans Superficialis in Children
Authors: Ebigbo Nonyelum , Park Jason Y. , Cheng Edaire , Gurram Bhaskar
Published: May 2021

Objectives:

Esophagitis dissecans superficialis (EDS) is a desquamative disorder of the superficial esophageal epithelium with variable clinical characteristics. Endoscopically, there is an appearance of superficial peeling of sheets of epithelium. Histologically there is 2‐toned epithelium with coagulative necrosis of the superficial epithelium. Currently, there is paucity of data regarding this condition in children.

Methods:

A 10‐year retrospective search of the pathology information system was performed for cases with a pathologic diagnosis of EDS in a tertiary care pediatric center. Demographic data, clinical history, endoscopic findings, and histopathologic reports were reviewed.

Results:

Thirteen patients (9 girls; ages 3–18 years), were identified with histologic findings of EDS. Esophageal food impaction, dysphagia, vomiting, and abdominal pain were the most common presenting symptoms. Sixty‐nine percentage of the patients had underlying comorbidities and 76% were on at least 1 medication chronically. Eosinophilic esophagitis (23%), inflammatory bowel disease (23%), and gastroesophageal reflux disease (GERD) (15%) were the most common associated diagnoses. Of the 13 patients, 5 had repeat endoscopies showing complete resolution of EDS with no complications.

Conclusions:

EDS is an under‐recognized entity that endoscopists should be familiar with. In our series, the most prevalent associations were with food impaction and eosinophilic esophagitis (EoE). Contact injury and/or inflammation may precede the development of EDS. Pediatric EDS appears to be an incidental finding without significant morbidity or mortality.
Safe Handling of Hazardous Drugs in Home Infusion
Authors: Eisenberg Seth , Klein Christina
Published: May 2021

Chemotherapy agents used for cancer treatment are considered hazardous drugs (HDs). Guidelines and standards for handling HDs have been in place for several decades to protect oncology nurses working in hospitals and outpatient infusion areas. However, chemotherapy is frequently being administered in home settings, often by infusion nurses who do not necessarily have the requisite knowledge and training. Providing appropriate education for home infusion nurses is key to ensuring they are practicing in a manner that minimizes potential exposure to HDs.
Attached to Virtual Dreams
Authors: Costanzo Antonino , Santoro Gianluca , Russo Santi , Cassarà Maria Silvia , Midolo Laura Rosa , Billieux Joël , Schimmenti Adriano
Published: April 2021

Maladaptive daydreaming describes excessive fantasy activity that interferes with an individual's life. Surprisingly, the precursors of maladaptive daydreaming and its role in excessive involvement in virtual worlds have been scarcely investigated. In the current study, we examined the relationships among attachment styles, maladaptive daydreaming, and problematic social media use (PSMU) in a sample of community-dwelling adults. Eight hundred seventy-seven participants between 18 and 68 years old were recruited via an online survey and asked to fill out self-reported measures on attachment styles, maladaptive daydreaming, and PSMU. Mediation analyses showed that maladaptive daydreaming is a significant mediator in the relationships between preoccupied and fearful attachment styles and PSMU, suggesting that maladaptive daydreaming partly explains the established link between insecure attachment styles and excessive use of social media. Individuals with PSMU fostered by maladaptive daydreaming may benefit from clinical interventions that promote the use of adaptive regulatory strategies to develop feelings of security and self-confidence that may serve to reduce the excessive involvement in social media.
Assisting Learners to Understand and Incorporate Functions of Clinical Judgment Into Nursing Practice
Authors: Sommer Sheryl K. , Johnson Janean D. , Clark Cynthia M. , Mills Christine M.
Published: May 2021

Background

Mastering clinical judgment (CJ) skills is an essential competency for nurses in all health care environments.

Problem

Complexities of the health environment combined with the intricacies of nursing practice can pose potential risks to client safety.

Approach

Over a 2-year period, a 3-phased approach using (1) survey results from nurses in education and practice, (2) discussion forums, and (3) a series of think tanks that comprised nurse educators resulted in the development of the Guide for CJ.

Outcomes

The Guide for CJ provides nurse educators with an evidence-based resource to promote CJ skills in nursing students. The environmental and individual factors and expected nurse responses and behaviors contained in the Guide are well-aligned with the cognitive operations contained in the National Council of State Boards of Nursing Action Model.

Conclusions

Educators may use the Guide to support faculty development and operationalize CJ to develop a variety of learning strategies for use in multiple learning environments.
Creating Collaborative Relationships With Historically Black Colleges and Universities
Authors: Hudson Tamika , Steed Julia , Parker Shaunna , Johnson Rolanda , Norman Linda
Published: May 2021

Background

The lack of a diverse nursing workforce and inclusive nursing student pipeline initiatives can impact existing health disparities in the United States.

Problem

Gaps in the representation of future Black nurses in schools of nursing provide missed opportunities for cultural congruence and awareness.

Approach

Developing collaborative relationships with historically Black colleges and universities (HBCUs) for recruitment is a mutually beneficial strategy. Undergraduate interns from 3 HBCUs attended a 6-week summer nursing immersion program at a graduate school of nursing on the campus of a predominately White institution. The aim was to provide awareness of the nursing profession and mentorship for further exploration into the profession.

Conclusions

The program managed by Black nurse faculty provides a recruitment strategy that serves as a framework to support the financial, emotional, and social needs of prospective Black nursing students.
Urban Sexual Health Clinic Patients With “Undetermined Risk” for HIV Are Less Likely to Receive Preexposure Prophylaxis
Authors: Platt Laura , Shebl Fatma M. , Qian Yiqi , Bunda Bridget , Ard Kevin L. , Bassett Ingrid V.
Published: May 2021

Background

New diagnoses of HIV increasingly occur among people who fall outside traditional transmission risk categories. This group remains poorly defined, and HIV prevention efforts for this group lag behind efforts for patients in other risk groups.

Methods

We conducted a retrospective review of patient visits at sexual health clinics in Boston, MA, over a 14-month period. Patients were classified into Centers for Disease Control and Prevention–defined HIV transmission risk categories. We compared frequencies of sexually transmitted infections (STIs), HIV, preexposure prophylaxis (PrEP) indications, and PrEP prescriptions. Predictors of HIV or STI among patients in the undetermined risk category were assessed with logistic regression.

Results

There were 4723 clinic visits during the study period. Patients in the undetermined risk group constituted the largest proportion (55.8%), followed by men who have sex with men (MSM; 42.7%). The proportion of visits by patients in the undetermined risk group with an indication for PrEP was low (28.0%) compared with MSM (91.3%) and MSM who also inject drugs (93.8%); however, the absolute number was high (737). Among patients with an indication for PrEP, those in the undetermined risk group were least likely to receive a prescription. Behavioral risk factors were poorly predictive of STI or HIV among patients in the undetermined risk group.

Conclusions

Patients with undetermined risk for HIV constituted a large proportion of clinic visits and had a large volume of sexual health needs but rarely received PrEP when indicated. To end the HIV epidemic in the United States, prevention efforts must include people who fall outside traditional risk categories.