bluuebunny/crossref_metadata_2025 huggingface dataset:
Stereotactic Radiosurgery for Vestibular Schwannoma With Radiographic Brainstem Compression
Authors: De Leo Alexandra N. , Shah Anjay , Li Jonathan , Morris Christopher G. , Bova Frank J. , Friedman William A. , Amdur Robert J.
Published: November 2023

Objective:

The safety of single-treatment stereotactic radiosurgery (SRS) for vestibular schwannoma (VS) with radiographic evidence of brainstem compression but without motor deficit is controversial. Data on linear accelerator (linac)-based SRS in this setting are scarce. We address this with an outcomes report from an unselected series of patients with VS with radiographic brainstem compression treated with linac SRS.

Methods:

We included 139 patients with unilateral VS (any size) with radiographic brainstem compression (all without serious brainstem neurological deficits). The SRS prescription dose was 12.5 Gy (single fraction) using 6MV linac-produced photon beams, delivered with a multiple arc technique. Inclusion criteria required at least 1 year of radiographic follow-up with magnetic resonance imaging. The primary endpoint was freedom from serious brainstem toxicity (≥grade 3 Common Terminology Criteria for Adverse Events v5); the secondary was freedom from enlargement (tumor progression or any requiring intervention). We assessed serious cranial nerve complications, excluding hearing loss, defined as Common Terminology Criteria for Adverse Events v5 grade 3 toxicity.

Results:

Median magnetic resonance imaging follow-up time was 5 years, and median tumor size was 2.5 cm in greatest axial dimension and 5 ml in volume. The median brainstem D0.03 ml=12.6 Gy and median brainstem V10 Gy=0.4 ml. At 5 years, the actuarial freedom from serious brainstem toxicity was 100%, and freedom from tumor enlargement (requiring surgery and/or due to progression) was 90%. Severe facial nerve damage in patients without tumor enlargement was 0.9%.

Conclusion:

Linac-based SRS, as delivered in our series for VS with radiographic brainstem compression, is safe and effective.
Hyperfractionated Accelerated Radiotherapy Versus Stereotactic Body Radiotherapy in the Treatment of Limited-Stage Small Cell Lung Cancer
Authors: Yang Lujie , Lu Xianfeng , Luo Jiamin , Huang Danju , Dai Xiaoyan , Yang Yuxin , Dai Nan , Xiong Yanli
Published: November 2023

Background:

Concurrent chemoradiotherapy based on hyperfractionated accelerated radiotherapy (HART) is the first-line recommended regimen for the treatment of small-cell lung cancer (SCLC). However, Stereotactic Body Radiotherapy (SBRT) is also regarded as an effective treatment for limited-stage (LS) SCLC, and the efficacy and safety of HART versus SBRT stay controversial.

Methods:

In this study, 188 LS-SCLC patients were retrospectively divided into two groups receiving chemotherapy combined with either HART or SBRT. In HART group, patients received 4500 cGy in 30 fractions, administered twice daily for 3 weeks. Whereas in the SBRT group, a total radiation dose of 4000–4500 cGy was delivered in 10 fractions over 2 weeks. Thirty-three pairs of patients were finally included for next analysis.

Results:

The estimated objective response rates were 63.6 % (21/33) and 78.8 % (26/33) in HART group and SBRT group, respectively (P = 0.269). Furthermore, there was no significant difference between HART and SBRT groups in overall survival (26 months vs. 29 months, P = 0.362) and progression free survival (11 months vs. 15 months, P = 0.223). As for the adverse events, toxicity of both groups is similar and slight that no grade 4 event was observed. Grade 3 pneumonitis cases were all occurred in the HART group (9.1%, 3/33, P = 0.238), and grade 3 esophagitis cases were all occurred in the SBRT group (6.1%, 2/33, P = 0.492).

Conclusions:

Compared with HART, SBRT could be another effective treatment with satisfactory safety for the concurrent chemoradiotherapy in patients with LS-SCLC.
A Comparative Study of CD56 and Smooth Muscle Actin Expression in Basal and Squamous Cell Carcinomas
Authors: Yirmibes Selin , Balaban Adim Saduman
Published: November 2023

Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the 2 most common types of nonmelanoma skin tumors. Clinical or histopathological diagnostic challenges are encountered on occasion. CD56 and smooth muscle actin (SMA) are highly expressed in BCCs. We aimed to investigate the frequency of these markers, along with B-cell lymphoma 2 (Bcl-2) and Ki67. This study was conducted to propose a method that could possibly be of diagnostic value. One hundred twenty-eight BCC and 39 SCC cases were included in this study. CD56, SMA, Bcl-2, and Ki67 immunohistochemical stains were applied. Ninety-nine (77.3%) BCC and 6 (15.4%) SCC cases showed CD56 immunoreactivity. SMA expression was detected in 78.1% of BCC and 5.1% of SCC cases. CD56, SMA, and Bcl-2 expressions were significantly higher in BCC cases. The Ki67 proliferation index was found significantly higher in SCC cases. When basosquamous carcinoma cases were compared with SCC cases, a significant correlation between tumors and expression of CD56, SMA, and Bcl-2 were obtained. CD56 and SMA, in addition to Bcl-2, favor BCC. Ki67 should also be included in the panel to demonstrate the proliferative activity.
Approach to the so-called “Invisible Dermatosis”: When Subtle Histopathological Findings Guide Diagnosis
Authors: Llamas-Velasco Mar , Pérez-Muñoz Noelia , Rozas-Muñoz Eduardo , Ballester Rosa , Posada Rodolfo , Figueras Maite Fernández
Published: November 2023

Invisible dermatosis is a concept that can be applied either to clinical or histopathological findings. We will focus on the dermatopathological aspect of this invisible dermatosis that can be seen as dermatosis with subtle histopathological findings that are mandatory to known to stablish the diagnosis. With a proper approach facing in depth the different skin layers from stratum corneum to subcutaneous tissue combined with some especial stains, special investigations and mostly a proper clinicopathological correlation, the problem of missing out a diagnosis can be decreased. We will review the general aspects for diagnosis and the peculiar findings of an in-depth review of them because it is important to note that minor changes on a skin biopsy do not mean it is disease free. We will review classic clues, we will add some new useful ones, and we will also provide a guide on the special stains helpful, such as periodic acid–Schiff when facing fungi, orcein-Giemsa and van Gieson when altered elastic fibers are suspected, or Pearl and Masson Fontana when an altered skin pigmentation is suspected.
NUT Expression Is of Diagnostic Utility in the Distinction of Digital Papillary Carcinoma From Poroid Hidradenoma
Authors: Iacobelli Jean , Harvey Nathan T. , Ardakani Nima Mesbah , Ng Lydia , Preston Henry , Wood Benjamin A.
Published: November 2023

The distinction between digital papillary adenocarcinoma (DPAC) and benign cutaneous adnexal tumors is clinically important and can be challenging. Poroid hidradenoma frequently occurs at acral sites and can show a number of histological features, which overlap with digital papillary adenocarcinoma. Recent work has shown that YAP1–NUTM1 fusions are frequent in poroid hidradenoma and are associated with nuclear protein in testis (NUT) expression by immunohistochemistry. We evaluated the expression of NUT-1 by immunohistochemistry in 4 cases of DPAC and 4 cases of poroid hidradenoma. Three of 4 cases of poroid hidradenoma showed strong NUT-1 expression, with no staining in any of the cases of DPAC. These results suggest that NUT-1 immunohistochemistry may be a useful additional tool in evaluating this differential diagnosis.
Antibiotic Use in Patients With COVID-19
Authors: Hooshmand Niloofar , Zarei Batool , Mireskandari Zahra Sadat , Sheybani Fereshte , Haddad Mahboubeh , Elyasi Sepideh , Morovatdar Negar , Abdollahi Dashtbayaz Hamed Hossein
Published: November 2023

Introduction

Antimicrobial resistance is a serious threat to public health. The ongoing antimicrobial resistance pandemic has been fueled by the COVID-19 pandemic.

Methods

We analyzed patients 15 years or older with COVID-19 who were admitted to a teaching hospital in Mashhad, Iran, during the period between the third and fourth COVID-19 waves. COVID-19 was diagnosed if the SARS-COV-2 (severe acute respiratory syndrome coronavirus 2) polymerase chain reaction test was positive in patients with compatible clinical syndromes.

Results

Overall, 532 episodes of COVID-19 were diagnosed. The median age of patients was 61 years (interquartile range, 48–73). One hundred twenty-five patients (23.4%) with COVID-19 died, and 165 (31%) experienced major complications. Over the study period, 134 DDD (defined daily dose) per 100 hospital bed days of antibacterial were used. Glycopeptides, third-generation cephalosporins, and carbapenems were the antibacterials most frequently used, based on the DDD per 100 hospital bed days. In a multivariate analysis, factors associated with antibacterial prescription in COVID-19 patients were lung involvement of greater than 50% (odds ratio [OR], 14.6), C-reactive protein of greater than 100 mg/L (OR, 3.35), and hypoxia (OR, 3.06). Univariate but not multivariate analysis showed that antibiotic use in COVID-19 patients was associated with 4 times increase in the chance of death (OR, 4.23).

Conclusion

Our study highlights a high rate of antibacterial use in COVID-19 patients. Hypoxia, C-reactive protein of greater than 100 mg/L, and severe lung involvement were associated with a higher rate of antibacterial prescription. The patients who received antibiotics died 4.23 times more often than patients treated without antibiotics. These findings emphasize the need for integrating antimicrobial stewardship programs as an integral part of the pandemic response and the need for improving diagnostic tests for early detection of bacterial coinfections in COVID-19 patients.
Epidemiology and survival of patients with spinal meningiomas: a large retrospective cohort study
Authors: Wang Yang , Wang Xiaoman , Yu Tong , Wang Zhonghan , Zhang Han , Chao Bo , Luo Wangwang , Jiang Weibo , Li Mufeng , Jiao Jianhang , Wu Minfei
Published: November 2023

Introduction:

Spinal meningiomas (SMs) are relatively rare central nervous system tumors that usually trigger neurological symptoms. The prevalence of SMs is increasing with the aging of the global population. This study aimed to perform a systematic epidemiologic and survival prognostic analysis of SMs to evaluate their public health impact and to develop a novel method to estimate the overall survival (OS) at 3-, 5- and 10-year in patients with SMs.

Methods:

5158 patients with SMs were recruited from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2019. Firstly, descriptive analysis was performed on the epidemiology of SMs. Secondly, these individuals were randomly allocated to the training and validation sets in a ratio of 7:3. Kaplan-Meier method and Cox regression analysis were utilized in the training set to identify independent prognostic factors and to construct a nomogram for survival prognosis. Subsequently, the discriminative power, predictive performance, and clinical utility of the nomogram were evaluated by receiver operating characteristic (ROC) curve and decision curve analysis (DCA). Finally, a mortality risk stratification system and a network-based dynamic nomogram were constructed to quantify the risk of mortality in patients with SMs.

Results:

The annual age-adjusted incidence rates (IRs) of SMs increased steadily since 2004, reaching a rate of 0.40 cases per 100,000 population in 2019, with a female-to-male ratio of approximately 4:1. The age groups of 50-59, 60-69, and 70-79 years old were the most prevalent ages for SMs, accounting for 19.08%, 24.93%, and 23.32%, respectively. In addition, seven independent prognostic factors were identified to establish a prognostic nomogram for patients with SMs. The DCA and ROC curve indicated that the nomogram had high clinical utility and favorable accuracy. Moreover, the mortality risk stratification system effectively divided patients into low-, middle-, and high-risk subgroups.

Conclusions:

SMs are relatively rare benign spinal tumors prevalent in the white elderly female population. Clinicians could use the nomogram to personalize the prediction of the OS probability of patients with SMs, categorize these patients into different mortality risk subgroups, and develop personalized decision-making plans. Moreover, the web-based dynamic nomogram could help to further promote clinical application and assist clinicians in providing personalized counseling, timely monitoring, and clinical assessment for patients.
Transperineal anastomotic posterior urethroplasty with bulbocavernosus flap and fibrin sealant in the complicated posterior urethral stricture reconstruction-A retrospective cohort study
Authors: Wang Menghua , Zhou Liang , Liao Banghua , Ye Donghui , Ma Yucheng , Jian Zhongyu , Yuan Chi , Jin Xi , Li Hong , Wang Kunjie
Published: November 2023

Background:

Management of complicated posterior urethral stricture is challenging. Modified transperineal anastomotic urethroplasty (TAU) with bulbocavernosus flap interposition and human fibrin sealant provides another treatment option. We aimed to evaluate whether this technique could improve the success rate in the complicated posterior urethral stricture reconstruction in this study.

Materials and methods:

Between 2016 and 2019, 48 patients underwent either conventional or modified TAU. The criteria for success included both the absence of clinical symptoms and no need for further surgical intervention during follow-up.

Results:

Twelve patients underwent the modified TAU (group A) using bulbocavernosus flap interposition and human fibrin sealant. Thirty-six patients underwent the traditional end-to-end anastomotic urethroplasty (group B). Follow-up was 24.3–57.2 months. The patients in group A had a higher surgery success rate compared to the patients in group B (91.7 vs. 63.9%, P=0.067), with a quasi-significant result. Besides, no postoperative complications were observed in group A, while two individuals in group B had urinary incontinence, but the difference was not significant (0 vs. 5.6%, P=0.404).

Conclusion:

Based on the preliminary results, modified TAU with bulbocavernosus flap interposition and human fibrin sealant is a safe and feasible technique for complicated posterior urethral stricture reconstruction.
COVID-19 Pandemic is Associated With Increased Prevalence of GERD and Decreased GERD-related Quality of Life
Authors: Fauzi Ahmad , Simadibrata Daniel M. , Friska Dewi , Syam Ari F.
Published: November 2023

Introduction:

The prevalence of gastroesophageal reflux disease (GERD) is expected to increase during the pandemic due to unexpected, sudden lifestyle changes such as decreased physical activity and worsening mental conditions. Here, we aim to explore the difference in the prevalence of GERD and GERD-related quality of life (QoL) in Indonesia during the COVID-19 pandemic compared with before the COVID-19 pandemic.

Methods:

Retrospective analysis of the Indonesian GERD Questionnaire study, a cross-sectional study utilizing an online form of the GERD Questionnaire, was done to compare the prevalence of GERD between March 2, 2018 to March 1, 2020 (prepandemic group) and March 2, 2020 to March 1, 2022 (pandemic group). The prevalence odds ratios between the 2 groups were calculated using χ2.

Results:

A total of 9800 participants were included in the analysis; 1807 and 7993 were allocated to the pandemic and prepandemic groups, respectively. The prevalence of GERD in the pandemic and prepandemic groups were 67.9% and 61.8%, respectively (prevalence odds ratio: 1.31; 95% CI: 1.17-1.46).

Conclusion:

During the COVID-19 pandemic, the prevalence of GERD, heartburn, and those who reported impaired GERD-related quality of life increased. Regurgitation was the most common symptom reported by participants.
Outcomes of Endoscopic Ultrasound-guided Fine Needle Biopsy Using a Novel Hydrostatic Stylet Tissue Acquisition Technique
Authors: Magahis Patrick T. , Westerveld Donevan , Simons Malorie , Carr-Locke David L. , Sampath Kartik , Sharaiha Reem Z. , Mahadev SriHari
Published: November 2023

Background:

Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) is frequently used to obtain core samples of solid lesions. Here, we describe and evaluate a novel hydrostatic stylet (HS) technique designed to optimize core sample acquisition, reporting diagnostic yield, efficacy, and safety relative to the conventional stylet slow-pull (SP) technique.

Methods:

A novel HS technique was developed and validated retrospectively. Consecutive patients who underwent EUS-FNB with core biopsy of solid lesions through either the HS or SP technique between January 2020 and April 2022 were included. Exclusion criteria included cystic lesions, nonlesional liver biopsies, and specimens sent for cytologic analysis only. Patient and lesion characteristics, number of passes, sample adequacy, and adverse events were compared between the two techniques.

Results:

A total of 272 patients were included with 138 in the HS group and 134 in the SP group. Lesion size and anatomic distribution were similar in both groups. Compared with the SP approach, the HS technique demonstrated significantly higher sample adequacy (97.8% vs 83.6%,P< 0.001), higher sensitivity (97.1% vs 89.7%,P= 0.03), and lower mean number of passes (1.2 vs 3.3,P< 0.001). Rates and severity of adverse events in the HS group were comparable to the SP group and existing literature. Similar associations were observed in pancreatic and nonpancreatic lesion subanalyses.

Conclusions:

The novel HS technique demonstrated excellent biopsy sample adequacy and diagnostic yield while requiring fewer passes to obtain diagnostic specimens compared with a conventional EUS-FNB approach. Further prospective evaluation is needed to confirm these pilot findings and optimize EUS-FNB acquisition techniques.
Pregnancy, cardiovascular health, and microchimerism
Authors: Søndergaard Sara Hallum , Kamper-Jørgensen Mads
Published: November 2023

Purpose of review

To provide an updated review of scientific literature concerning associations between pregnancy and cardiovascular health among women, and to discuss a possible impact of microchimerism on the association.

Recent findings

In most studies, pregnancy and childbirth is associated with increased risk of cardiovascular disease in women. Some ascribe the association mainly to lifestyle, whereas others suggest that pregnancy itself negatively affects women's cardiovascular health. Pregnancy is a natural source of microchimerism, which in turn markedly affects female health. The only study published in the area surprisingly shows that among middle-aged women, male-origin microchimerism (MOM) is associated with half the risk of developing ischemic heart disease (IHD). No similar association is found between MOM and ischemic stroke.

The sparse evidence published suggests reduced risk of developing IHD among MOM-positive women. Despite the association being biologically plausible, replication of the findings is warranted to support that this is not a chance finding.
Evaluating the factors affecting clinical outcomes in critically ill COVID-19 unvaccinated patients admitted to the intensive care unit in a lower-middle-income country
Authors: Heydari Fatemeh , Karimpour-razkenari Elahe , Azadtarigheh Parnian , Vahdatinia Alireza , Salahshoor Ali , Alipour Abbas , Moosazadeh Mahmood , Gholipour Baradari Afshin , Monajati Mahila , Naderi-Behdani Fahimeh
Published: November 2023

Background:

COVID-19, the most destructive pandemic of this century, caused the highest mortality rate among ICU patients. The evaluation of these patients is insufficient in lower-middle-income countries with limited resources during pandemics. As a result, our primary goal was to examine the characteristics of patients at baseline as well as their survival outcomes, and propose mortality predictors for identifying and managing the most vulnerable patients more effectively and quickly.

Methods:

A prospective analysis of COVID-19 ICU-admitted patients was conducted in our healthcare centre in Iran, from 1 April until 20 May 2020. Ninety-three patients were included in the study, and all were unvaccinated. A multi-variate logistic regression was conducted to evaluate mortality-associated factors.

Results:

There were 53 non-survivors among our ICU-admitted patients. The mean duration from symptoms’ onset to hospitalization was 6.92 ± 4.27 days, and from hospitalization to ICU admission was 2.52 ± 3.61 days. The average hospital stay for patients was 13.23 ± 10.43 days, with 8.84 ± 7.53 days in the ICU. Non-survivors were significantly older, had significantly lower haemoglobin levels and higher creatine phosphokinase levels compared to survivors. They had marginally lower SpO2 levels at admission, higher vasopressor administrations, and were intubated more significantly during their ICU stay. The use of immunosuppressive drugs was also significantly higher in non-survivors. Logistic regression revealed that a one-point increase in APACHE II score at ICU admission increased mortality by 6%, and the presence of underlying diseases increased mortality by 4.27 times.

Conclusion:

The authors presented clinical mortality prediction factors for critically ill patients infected with COVID-19. Additional studies are necessary to identify more generalized mortality indicators for these patients in lower-middle-income countries.
Correlation between color vision, visual acuity, contrast sensitivity and photostress recovery in the visually impaired: a cross-sectional study
Authors: Almaliotis Diamantis , Almpanidou Stavroula , Chatzimbalis Theodosis , Nikolaidou Anna , Talimtzi Persefoni , Karampatakis Vasileios
Published: November 2023

Background:

To investigate the correlation of colour vision, visual acuity, contrast sensitivity, and photostress recovery time test scores in visually impaired patients.

Materials and methods:

A total of 133 subjects were enroled and 133 eyes were examined. The pathological group consisted of 76 (57.1%) males with an average age of 68.0 (SD=13.2) and 57 (42.9%) females, with an average age of 68.1 (SD=15.2), Mann–Whitney U test was used to evaluate the differences in K-colour tests, HRR, visual acuity, Contrast Sensitivity test and photostress recovery time test between two different groups of severity.

Results:

Correlations were found among colour vision tests, visual acuity, contrast sensitivity, and photostress recovery time scores in eyes with age-related macular degeneration, with diabetic retinopathy, with optic nerve diseases, and various other retinal diseases (P<0.05). In patients with moderate-visual impairments.

Conclusions:

The colour vision test scores correlate with the scores of visual acuity, contrast sensitivity, and photostess recovery time test. It may be a useful clinical surrogate for functional vision.
Diversity, Equity, and Inclusion Start From Within
Authors: Fink-Samnick Ellen
Published: November 2023

The values associated with diversity, equity, and inclusion (DEI) initiatives are well known to case managers. All values align with the ethical tenets of case management and its established resources of guidance, Yet, how effective is case management at applying these values within the workforce. Opportunities exist for implementation of an inclusive case management model that heeds with quality mandates and ethical expectations for practice.
Development of an Emergency Department Case Management Case-Finding Tool
Authors: Gallagher David , Bentley Barbara , Barry Ashley , Fraccola Amy , Santos Rosimeire , Glenn Adam , Howard James , Kamath Aparna , Flanagan Katie
Published: November 2023

Purpose of Study:

Identifying emergency department (ED) patients who are at high risk for return visits is an important goal for case management to improve patient care. This quality improvement study describes the development and evaluation of the Emergency Department Case Management Priority Score (EDCMPS), an electronic medical record (EMR)-based “case-finding” system, and its ability to identify these high-risk patients. In addition, the authors present data about its acceptability among emergency department case managers (ED CMs).

Primary Practice Settings:

Emergency departments with case management availability and staffing.

Methodology and Sample:

A retrospective analysis at Duke University Hospital ED compared patient data pre- and postimplementation of the EDCMPS. The tool was developed using the LEAN and Plan–Do–Study–Act (PDSA) quality improvement methodologies, with ED CM participation. ED return and hospitalization rates within 7 and 30 days between both methods were compared, and a survey evaluated CM satisfaction with the EDCMPS.

Results:

The 2-month preintervention period (July 1, 2022, to August 31, 2022) included 8,677 patients discharged from the ED, with 897 patients (10.3%) identified as at high risk for return based on the previous manual methodology. In the 3-month postintervention period (September 1, 2022, to November 30, 2022), there were 13,566 patients discharged, with 692 patients (5.1%) identified as at high risk for return using the EDCMPS. The EDCMPS outperformed the manual method, yielding a significantly higher odds ratio (OR) for 7- and 30-day ED return or hospitalization (e.g., 30-day any return OR = 4.21 vs. 1.69). The survey showed broad ED CM agreement on the tool's superior performance, especially in organizing outpatient resources and referring to support programs. However, challenges in securing primary care follow-up, housing, and health insurance applications were identified. The tool's collaborative development approach ensured its fit to ED CM needs, contributing to its success.

Implications for Case Management Practice:

The EDCMPS showcases promise in enhancing ED CM efficiency, with strong frontline staff endorsement. It pinpoints areas needing focus for patient support and has the potential to reduce ED revisits and therefore health care utilization. Its methodology offers insights for similar future implementations in health care institutions.
The Magnet Recognition Program® and Its Influence on Hospital Rankings
Authors: Newberry Lynn W.
Published: November 2023

In the complex landscape of healthcare, 2 prominent entities have emerged as benchmarks for quality and excellence: the Magnet Recognition Program® and theU.S. News & World Reportrankings. Although distinct in their focus, these 2 organizations share a common goal of driving improvements in healthcare standards and patient outcomes. The synergy between the Magnet Recognition Program® andU.S. News & World Reportis a testament to their impact on shaping the healthcare industry in the United States.
Developing Leaders and Fighting Burnout
Authors: Thrall Terese Hudson
Published: November 2023

This year, Sharon Pappas, PhD, RN, NEA-BC, FAAN, Chief Nurse Executive (CNE) at Emory Healthcare (EHC), Atlanta, Georgia, received the American Organization for Nursing Leadership (AONL) prestigious Lifetime Achievement Award, which honors an AONL member recognized by the nursing community as a significant leader in the nursing profession and who has served AONL in an important leadership capacity. As CNE of Georgia's largest healthcare system, she leads and supports a Magnet® nursing culture across EHC, with the goal of achieving Magnet designation for the entire EHC system. Dr Pappas was commended for her leadership in leading the EHC incident command during COVID-19 where she focused on providing exceptional patient care and supporting clinical nurses caring for critically ill patients.
Violent Event Severity Tool for Reporting Violent Incidents
Authors: Kim Son Chae , Kim Youngho Paul
Published: November 2023

OBJECTIVES

To explore the usefulness of the Violent Event Severity Tool (VEST).

BACKGROUND

The Joint Commission and many governing bodies require establishing workplace violence prevention programs in hospitals. Inconsistent processes have hampered the efficacy evaluation of such programs for collecting and reporting violence. The VEST was developed as a standardized tool for capturing violence data.

METHODS

Ninety-six healthcare workers attending the 2022 Magnet® conference completed the survey. The VEST includes 6 types and 4 intensities of violent incidents.

RESULTS

Most participants reported that the VEST is easy to use (79%), relevant (85%), and useful (85%). Fewer than half were satisfied with their incident report filing processes. Only 38% of participants experiencing grade 1 physical assault filed an incident report, whereas 70% and 100% experiencing grades 3 and 4 physical assaults filed.

CONCLUSIONS

The VEST appears to be a useful and relevant tool for consistent collection and reporting of various violence types and severities.
Mast Cell Concentrations in Pancreatic Disease Processes
Authors: Wynn Lindsey , Hodges Victoria , Criswell Sheila
Published: November 2023

Mast cells enumeration has been performed using various histologic staining techniques with the goal of elucidating the influence mast cells exert on pathologic processes. In this study, 77 human pancreatic tissues evidencing morphologically normal pancreas, benign fibrotic changes, endocrine tumors, and adenocarcinoma were evaluated using Wright stain and immunohistochemistry markers for tryptase and CD117. Mast cell counts were similar with tryptase and CD117 but were both significantly higher than counts obtained with the Wright stain. Furthermore, all analyses demonstrated that endocrine tumors and morphologically normal pancreatic tissues had significantly lower mast cell counts as compared with benign fibrosis and adenocarcinoma suggesting that the highly fibrotic nature of both pancreatitis and adenocarcinoma are related to increased mast cell concentrations.
Mindfulness-Based Stress Reduction Reduces Proinflammatory Gene Regulation But Not Systemic Inflammation Among Older Adults: A Randomized Controlled Trial
Authors: Lindsay Emily K. , Marsland Anna L. , Cole Steven W. , Dutcher Janine M. , Greco Carol M. , Wright Aidan G.C. , Brown Kirk Warren , Creswell John David
Published: November 2023

Objective

Aging is associated with increased proinflammatory gene expression and systemic inflammation, and psychosocial stress may accelerate these changes. Mindfulness interventions show promise for reducing psychosocial stress and extending healthspan. Inflammatory pathways may play a role. In a sample of lonely older adults, we tested whether mindfulness training reduces proinflammatory gene expression and protein markers of systemic inflammation.

Methods

Lonely older adults (65–85 years; N = 190) were randomly assigned to an 8-week Mindfulness-Based Stress Reduction (MBSR) or matched Health Enhancement Program (HEP). Blood was drawn before and after the intervention and at 3-month follow-up. In peripheral blood mononuclear cells, RNA profiling was used to assess transcriptional regulation by proinflammatory nuclear factor κB (NF-κB) as well as β-adrenergic cAMP response element-binding protein (CREB), antiviral interferon regulatory factor (IRF), and glucocorticoid receptor (GR) transcription factors. Plasma was assayed for proinflammatory markers interleukin 6 (IL-6) and C-reactive protein (CRP). Analyses tested time (pre, post, follow-up) by condition (MBSR versus HEP) effects.

Results

MBSR reduced NF-κB (d = 0.17, p = .028) but did not alter CREB (d = 0.10, p = .20), IRF (d = 0.13, p = .086), or GR activity (d = 0.14, p = .063) relative to HEP over time. Contrary to predictions, there were no time by condition effects of MBSR compared with HEP on reducing circulating IL-6 or CRP.

Conclusions

In lonely older adults, MBSR reduced cellular proinflammatory gene regulation in ways that would predict reduced disease risk. However, no similar effect was observed for circulating protein markers of inflammation. These results provide specificity about how mindfulness interventions may impact distinct inflammatory markers among aging adults in ways that may have important implications for healthspan.

Trial Registration

Clinical Trials identifier NCT02888600.
Self-Acceptance and Purpose in Life Are Mechanisms Linking Adverse Childhood Experiences to Mortality Risk
Authors: O’Súilleabháin Páraic S. , D’Arcy-Bewick Sinéad , Fredrix Milou , McGeehan Máire , Kirwan Emma , Willard Meredith , Sesker Amanda A. , Sutin Angelina R. , Turiano Nicholas A.
Published: November 2023

Objective

Adverse childhood experiences (ACEs) are associated with an increased risk of premature mortality, but it is not clear why. Individuals with ACEs tend to have lower self-acceptance and purpose in life, which may be pathways between ACEs and risk of premature mortality. As such, we tested whether purpose and self-acceptance are mechanisms that link ACEs to mortality risk.

Methods

We used the Midlife in the United States Survey (N = 6218; mean [standard deviation] = 46.89 [12.94] years) to test whether these factors were indirect pathways between ACEs and mortality hazards over 24 years of follow-up. We used a comprehensive ACE measure that included 20 possible childhood adversities including emotional and physical abuse, household instability, socioeconomic climate, and ill health.

Results

ACEs significantly increased mortality risk (hazard ratio = 1.028, 95% confidence interval = 1.008–1.047, p = .006). Self-acceptance and purpose accounted for an estimated 15% and 4% of the ACEs-mortality relation, respectively. These effects withstood a range of adjustments and sensitivity analyses.

Conclusions

ACEs may affect mortality risk partially through lower self-acceptance and purpose during adulthood. Given that self-acceptance and purpose may change through intervention, these factors may be useful targets for individuals with ACEs that could lead to a longer life.
What Bedside Skills Could the Modern Rheumatologist Possess? Part II. “Certain Technical Procedures”
Authors: Ike Robert W. , McCoy Sara S. , Kalunian Kenneth C.
Published: November 2023

Rheumatologists have never been reluctant to adopt procedures that might enhance their diagnostic or therapeutic powers. Their propensity to penetrate the joints of the patients they were treating set them apart from the general internist. Since the 1980s, when a chance to look inside the joints they were treating attracted a few rheumatologists, other things that could be done at the bedside emerged with now an array of bedside procedures that could be part of a rheumatologist's skill set. Besides gains in diagnosis and/or therapy, each constitutes a chance to restore the physical contact between physician and patient, riven by factors of the last decade, such as electronic medical records and COVID. With such contact so important to satisfaction of the patient and physician alike, acquisition of proficiency in certain technical procedures described herein offers one path to begin restoring rheumatology to the richly fulfilling practice it once was.
A Historic Cohort Analysis of Radiographic and Serologic Findings in Patients With Scleroderma and Interstitial Lung Disease
Authors: Jhawar Nikita , Wilson Claire , Li Zhuo , Ma Yaohua , Abril Andy
Published: November 2023

Background/Objective

Few studies have investigated associations between rheumatologic serology patterns and different interstitial lung disease (ILD) patterns.

Methods

We present novel findings of a historic cohort study (n = 454) with data collected from 2011 to 2021 within our hospital system. In this institutional review board–approved study, data regarding rheumatologic serologies and ILD patterns were noted based on chart review in patients with scleroderma. The Kruskal-Wallis rank sum and χ
2 tests were used for statistical analysis.

Results

Results showed a statistically significant association between anti-U1 snRNP with lymphoid interstitial pneumonia, which has not been previously described.

Conclusions

We demonstrated novel serologic associations with ILD patterns, which have important clinical implications. More robust and high-powered studies are needed to elucidate the role of serologic testing and their association with ILD phenotypes.
Neonatal and Infant Lung Disorders
Authors: Yoon Se-Young , Concepcion Nathan David P. , DiPrete Olivia , Vargas Sara O. , Winant Abbey J. , Garcia-Peña Pilar , Chu Winnie C. , Kasznia-Brown Joanna , Daltro Pedro , Lee Edward Y. , Laya Bernard F.
Published: November 2023

A multitude of lung disorders ranging from congenital and genetic anomalies to iatrogenic complications can affect the neonate or the infant within the first year of life. Neonatal and infant chest imaging, predominantly by plain radiography and computed tomography, is frequently employed to aid in diagnosis and management; however, these disorders can be challenging to differentiate due to their broad-ranging, and frequently overlapping radiographic features. A systematic and practical approach to imaging interpretation which includes recognition of radiologic patterns, utilization of commonly accepted nomenclature and classification, as well as interpretation of imaging findings in conjunction with clinical history can not only assist radiologists to suggest the diagnosis, but also aid clinicians in management planning. The contents of this article were endorsed by the leadership of both the World Federation of Pediatric Imaging (WFPI), and the International Society of Pediatric Thoracic Imaging (ISPTI).
Computed Tomography–guided Percutaneous Lung Biopsy With Electromagnetic Navigation Compared With Conventional Approaches
Authors: Liu Qin , Guo Xiaoxia , Wang Ziyin , Xu Hao , Huang Wei , Liu Jingjing , Wang Zhongmin , Yan Fuhua , Wu Zhiyuan , Ding Xiaoyi
Published: November 2023

Purpose:

The purpose of this study was to assess the efficiency and safety of computed tomography (CT)-guided percutaneous biopsy of lung lesions with electromagnetic (EM) navigation and compare them with those of conventional approaches.

Materials and Methods:

Seventy-nine patients with lung or liver lesions who needed biopsies were enrolled in this trial. All patients were randomly assigned to the E group underwent CT-guided percutaneous biopsies with the EM navigation system or to the C group treated with conventional approaches.

Results:

In total, 27 patients with lung lesions were assigned to the E group, and 20 patients were assigned to the C group. The diagnostic success rate was 92.6% and 95% in both groups, respectively (P>0.9999). The median number of needle repositions in the E group was less than that in the C group (2.0 vs. 2.5, P=0.03). The positioning success rate with 1 or 2 needle repositions for the E group was significantly higher than the C group (81.5% vs. 50%, P=0.03). The median accuracy of the puncture location in the E group was better than that in the C group (2.0 vs. 6.6 mm, P<0.0001). The total procedure time lengthened in the E group compared with the C group (30.5±1.6 vs. 18.3±1.7 min, P<0.0001), but the number of CT acquisitions was not significantly different (P=0.08). There was no significant difference in complication incidence between the 2 groups (P=0.44).

Conclusion:

The EM navigation system is an effective and safe auxiliary tool for CT-guided percutaneous lung biopsy, but lengthen the procedure time.

Trial Registration:

ChiCTR2100043361, registered February 9, 2021—retrospectively registered (http://www.medresman.org.cn/uc/project/projectedit.aspx?proj=7591).
Cavernous Sinus Syndrome Caused by Noninvasive Fungal Maxillary Sinusitis
Authors: Peng XiaoLin , Yan Bo , Yang XiaoTong
Published: November 2023

It is rare that cavernous sinus complications are caused by maxillary sinus lesions because the locations of these lesions are some distant from each other. The authors describe an unusual presentation that the primary lesion was located in the maxillary sinus and triggered cavernous sinus syndrome and optic nerve symptoms. The most likely possibility was that the infection traveled retrograde along the vascular plexus. Removal of maxillary sinus lesions and establishment ventilation may achieve source control.
Radioimmunotherapy as a pathogen-agnostic treatment method for opportunistic mucormycosis infections
Authors: Carvalho Jorge L.C. , Malo Mackenzie E. , Allen Kevin J.H. , Frank Connor , Xiao Zhiwen , Jiao Rubin , Dadachova Ekaterina
Published: November 2023

Invasive fungal infections (IFI) such as mucormycosis are causing devastating morbidity and mortality in immunocompromised patients as anti-fungal agents do not work in the setting of suppressed immune system. COVID-19 pandemic has created a novel landscape for IFI in post-pandemic patients, which results from severe immune suppression caused by COVID-19 infection, comorbidities (diabetes, obesity) and immunosuppressive treatments such as steroids. The antigen-antibody interaction has been employed in radioimmunotherapy (RIT) to deliver lethal doses of ionizing radiation emitted by radionuclides to targeted cells and has demonstrated efficacy in several cancers. One of the advantages of RIT is its independence of immune status of a host which is crucial for immunosuppressed post-COVID-19 patients. In present work we targeted with RIT fungal pan-antigens 1,3-beta-glucan and melanin pigment, which are present in the majority of pathogenic fungi, thus making such targeting pathogen-agnostic. We demonstrated in experimental murine mucormycosis in immunocompetent and immunocompromised mice that 177Lutetium-labeled antibodies to these two antigens effectively decreased the fungal burden in major organs including the brain. These results are encouraging because they show the effectiveness of pathogen-agnostic RIT in significantly decreasing fungal burden in vivo, while they can be also potentially applied to treat the broad range of invasive fungal infections which express pan-antigens 1,3-beta-glucan or melanin.
Marinihelvus fidelis gen. nov., sp. nov., isolated from marine sediment, and genomic comparison with multiple genera
Authors: Zhang Meng-Di , Yue Yu-Yan , Sun Yang-Yang , Du Zong-Jun
Published: November 2023

A Gram-stain-negative, rod-shaped, non-gliding, non-flagellated, yellow, facultatively aerobic bacterial strain, designated as W260T, was isolated from marine sediment of Xiaoshi Island, Weihai, PR China. The cells of W260T were 0.3–0.5 µm wide and 1.5–2.0 µm long. Strain W260T grows optimally at a temperature of 33 °C (range, 15–37 °C), pH 8 (range, pH 6.5–9.5) and witha NaCl concentration of 3.0 % (w/v; range, 1–8 %). It has the highest sequence similarity to

Thiohalobacter thiocyanaticus

DSM 21152T (91.7 %), followed by

Wenzhouxiangella marina

MCCC 1K00261T (91.4 %) and

Thiohalospira alkaliphila

DSM 17116T (90.7 %). The similarity between strain W260T and the species

Thiohalophilus thiocyanatoxydans

DSM 16326T was 89.4 %. Genome sequencing revealed a genome size of 3 430 000 bp and a DNA G+C content of 64.5 mol%. The average nucleotide identity and digital DNA–DNA hybridization values between strain W260T and

W. marina

MCCC 1K00261T were 69.6 and 16.1–20.6 %, respectively. The predominant quinone was ubiquitin-8, and the major fatty acids were iso-C14 : 0 and iso-C16 : 0. The polar lipids consisted of phosphatidylethanolamine, phospholipid, phosphatidylglycerol, diphosphatidylglycerol and four unidentified lipids. Based on phenotypic, phylogenetic and chemotaxonomic information, it was determined that strain W260T represents a novel genus and species and it was given the name Marinihelvus fidelis sp. nov. The type strain is W260T (=MCCC 1H00471T=KCTC 92639T).
The unique face of anxious depression: Exaggerated threat but preserved positive valence reactivity
Authors: Ironside Maria , Kuplicki Rayus , Walker Ebony A. , Poplin Tate , Ramsey Cheldyn M. , Forthman Katherine L. , Nestor Melissa E. , Aupperle Robin L. , Guinjoan Salvador M. , Khalsa Sahib S. , Savitz Jonathan , Stewart Jennifer L. , Victor Teresa A. , Paulus Martin P.
Published: November 2023

Background

Even though anxious depression is among the most prevalent psychiatric conditions; its underlying neural and behavioral characteristics remain not well understood. This may be important to break down heterogeneity in depression. This study investigated the unique profile of individuals with anxious depression using affective startle modulation, a process known to independently probe appetitive/defensive systems and known to be affected by mood and anxiety disorders

Methods

236 depressed participants of the Tulsa 1000 study completed multi-level assessments including an emotional reactivity task with eye-blink startle measurement. To minimize bias due to covariates, 124 participants with comorbid depression and anxiety disorders (Dep+Anx) were matched with 62 participants with depression only (Dep). Eye-blink startle magnitudes during positive/negative visual cues were analyzed.

Results

The Dep group showed no affective modulation of startle. However, the Dep+Anx group showed potentiation from aversive cues and attenuation from appetitive cues. The Dep+Anx group also showed increased attenuation from appetitive cues compared to the Dep group. Dimensionally, the effect of self-report anxiety on startle was moderated by self-report depression.

Conclusions

Compared to individuals with depression, those with anxious depression demonstrate heightened positive/negative startle modulation, with depression levels moderating the link between anxiety sensitivity and startle reflex. The differences between these groups in processing aversive/appetitive information support the conclusion that these depression subtypes should be considered separately in future clinical trials. ClinicalTrials.gov identifier: #NCT02450240.

General scientific summary

This study suggests that there are striking differences between those with anxious and non-anxious depression. Specifically, these two groups differ in terms of threat reactivity measured by eye-blink startle response. This proposes that the two groups be separated in future clinical trials.
Contemporary HIV-1 consensus Env with redesigned hypervariable loops promote antibody binding
Authors: Bai Hongjun , Lewitus Eric , Li Yifan , Dussupt Vincent , Slike Bonnie , Mendez-Rivera Letzibeth , Schmid Annika , Wieczorek Lindsay , Polonis Victoria , Krebs Shelly J. , Ake Julie A. , Vasan Sandhya , Joyce M. Gordon , Townsley Samantha , Rolland Morgane
Published: November 2023

An effective HIV-1 vaccine must elicit broadly neutralizing antibodies (bnAbs) against the highly diverse Envelope glycoproteins (Env) present globally. Since Env with the longest hypervariable (HV) loops were more resistant to the cognate bnAbs than Env with shorter HV loops, we redesigned hypervariable loops for updated HIV-1 Env consensus sequences of subtypes B and C and circulating recombinant form AE (CRF01_AE). We reduced the length of V1HV, V2H, and V5HV while maintaining the integrity of the Env structure and glycan shield, and we modified V4HV to account for its diverse structural context. Redesiged HV loops consisted mainly of glycine and serine to limit strain-specific targeting. Redesigned consensus Env of subtype B or CRF01_AE demonstrated increased magnitude of binding responses to pooled plasma samples and representative bnAbs. Together with other antigen optimization techniques, consensus Env with redesigned hypervariable loops can improve future HIV-1 vaccine antigens to elicit bnAbs.