bluuebunny/crossref_metadata_2025 huggingface dataset:
The protective mechanism of SIRT3 and potential therapy in acute kidney injury
Authors: Yuan Jinguo , Zhao Jin , Qin Yunlong , Zhang Yumeng , Wang Anjing , Ma Rui , Han Mei , Hui Yueqing , Guo Shuxian , Ning Xiaoxuan , Sun Shiren
Published: June 2023

Acute kidney injury (AKI) is a complex clinical syndrome with a poor short-term prognosis, which increases the risk of the development of chronic kidney diseases and end-stage kidney disease. However, the underlying mechanism of AKI remains to be fully elucidated, and effective prevention and therapeutic strategies are still lacking. Given the enormous energy requirements for filtration and absorption, the kidneys are rich in mitochondria, which are unsurprisingly involved in the onset or progression of AKI. Accumulating evidence has recently documented that Sirtuin 3 (SIRT3), one of the most prominent deacetylases highly expressed in the mitochondria, exerts a protective effect on AKI. SIRT3 protects against AKI by regulating energy metabolism, inhibiting oxidative stress, suppressing inflammation, ameliorating apoptosis, inhibiting early-stage fibrosis and maintaining mitochondrial homeostasis. Besides, a number of SIRT3 activators have exhibited renoprotective properties both in animal models and in vitro experiments, but have not yet been applied to clinical practice, indicating a promising therapeutic approach. In this review, we unravel and summarize the recent advances in SIRT3 research and the potential therapy of SIRT3 activators in AKI.
Measurable radiation levels around individuals externally contaminated by nuclear fallout
Authors: Samuels Caleigh , Ansari Armin , Finklea Lauren , Hertel Nolan
Published: June 2023

During the early response to large-scale radioactive contamination events, people who are potentially affected need to be screened for radioactive contamination and public health staff need to triage individuals who may need immediate decontamination. This is typically done by screening individuals for external contamination using ionising radiation detection equipment. In this study, spatially and temporally dependent isotopic compositions from a simulated nuclear detonation and Monte Carlo methods were used to relate contamination activity levels to the measurable radiation levels at select distances away from an individual with whole-body contamination. Radionuclide-specific air kerma rate coefficients and Geiger–Mueller instrument response coefficients at five select distances from contaminated individuals are presented for 662 radionuclides. Temporally and spatially dependent incident-specific coefficients are presented for a hypothetical surface detonation of a 235U-fueled device.
Gender Dynamics During the Colombian Armed Conflict
Authors: Svallfors Signe
Published: June 2023

This article investigates gender dynamics during the Colombian armed conflict, where the ongoing peace process has had a unique focus on gender equality. Using a lens of militarized masculinity and original expert interviews with Colombian stakeholders in peacebuilding and human rights, the study analyzes how gender norms have been upheld and sanctioned in the context of conflict. Gender essentialisms have been reinforced by armed actors, with women’s and LGBT people’s bodies as central channels for reproducing traditional sociobiological roles. Expressions not conforming to the heterocisnormative gender order have been sanctioned with violence. While men have been disproportionally affected by combat violence, women and sexual and gender minorities have been more vulnerable to sexual violence and forced displacement. This militarization of gender norms in Colombia has constructed women’s and queer bodies as battlefields of war, severely undermining their safety, dignity, and autonomy.
Increasing Patient Access to Medical Cannabis Requires Federal Legislation
Authors: Johnson Noelene , Gordon Danielle
Published: June 2023

Marijuana's Schedule I classification remains an obstacle.
School Nurses
Authors: Cecrle Jessica
Published: June 2023

These nurses are beacons of public health for the student population.
Improving Medication Safety in an ICU
Authors: Fair Linda , Burns Carol , Lindsley John
Published: June 2023

Reported medication errors in an ICU at an academic teaching hospital raised concerns about adherence to safety protocols, including barcode scanning before medication administration. A group of nurse leaders, bedside nurses, and pharmacists formed a medication safety task force to increase compliance with barcode scanning and reduce reported medication errors in which failure to scan was a contributing factor.

Three task force members observed nurses' workflow in ICU medication administration. The members observed three nurses administer medications before scanning the barcode and three other nurses scan medications in a location where they were unable to see alerts on the computer. After the observations, the task force implemented three interventions: medication tables to provide a surface in front of the computer where medications could be placed when scanning; standardized workflow; and nursing staff education. Task force members then conducted postimplementation observations to evaluate improvement in barcode scanning compliance.

In the postintervention observations, all medications were scanned in front of the computer before administration, an increase of 27.3 percentage points (from 72.7% preintervention) in the barcode scanning compliance rate. The ICU also went 17 months in the postintervention period without a reported medication administration error in which failure to scan was a contributing factor.

The task force's observation of medication administration led to interventions that made it easier for nurses to adhere to best practice. Medication tables were a simple, sustainable intervention that used human factors principles to increase barcode scanning compliance.
Hackathons: Practical Problem-Solving for Nurse Educators
Authors: Bigott Veronica , Jensen Lillian , Zidek Stephanie
Published: June 2023

In looking for solutions to an organizational problem, the nursing education and professional development department at a large midwestern health care system used a novel approach—the hackathon. To align with Healthy People 2030 priorities and the health care system's strategic plan, the hackathon topics focused on community service opportunities relating to social determinants of health (SDOH). The goal of the hackathon was to find the most innovative strategy for SDOH education in a limited time frame. The teams of nurses that took part in the hackathon brainstormed, drafted, and rapidly refined a solution, then pitched their ideas to an expert panel. Each pitch was scored on feasibility, SDOH connection, creativity, sustainability, and potential nurse engagement. Three unique programming options emerged by the end of the event. The winning pitch was a peer-to-peer social media strategy engaging adolescents in health and wellness topics.
Increased Morbidity, Mortality in People with Post–COVID-19 Condition
Authors: Rosenberg Karen
Published: June 2023

According to this study:
Premature Infants Absorb Alcohol from Disinfectants
Authors: Rosenberg Karen
Published: June 2023

According to this study:
Trends in Characteristics of Prescription Opioid-related Poisonings among Older Adults in the United States, 2015–2021
Authors: Han Benjamin H. , Jewell Jennifer S. , Ding Belicia K. , Wu Nicholas C. , Cottler Linda B. , Palamar Joseph J.
Published: June 2023

Objectives

Few studies have considered how trends in opioid poisonings have changed among older adults. The objective of this study was to examine trends in fatal and nonfatal opioid-related poisonings (“exposures”) among older adults.

Methods

National poison center data were used to examine trends in characteristics of reported exposures to commonly prescribed opioids between 2015 and 2021 among adults 60 years or older. We estimated the proportion of opioid exposures by demographic characteristics, the specific opioid(s) involved, exposure type, route of administration, other substances co-used, and medical outcomes for each calendar year. We estimated whether there were linear changes in prevalence by year using logistic regression.

Results

Although there was a decrease in the number of opioid exposures within the study population from 7706 in 2015 to 7337 in 2021 (a 4.8% decrease, P = 0.04), exposures increased for adults aged 70 to 79 years (a 14.0% increase, P < 0.001). The proportion classified as “abuse” increased by 63.3% (P < 0.001). There were significant decreases in the proportion involving hydromorphone (a 23.3% decrease, P < 0.001) and morphine (a 22.0% decrease, P < 0.001), with an increase involving buprenorphine (a 216.0% increase, P < 0.001). The proportion increased for co-use of cocaine (a 488.9% increase, P < 0.001) and methamphetamine (a 220.0% increase, P = 0.02), with a decrease in co-use of benzodiazepines (a 25.5% decrease, P < 0.001). The proportion of major medical outcomes increased by 93.9% (P < 0.001).

Conclusions

National patterns of opioid-related poisonings are shifting among older adults, including the types of opioids involved and co-use of other drugs. These results can inform prevention and harm reduction efforts aimed at older adults.
Descending Control of Nociception Poorly Predicts the Development of Persistent Postsurgical Pain-like Behavior in Consomic Dahl S Rat Strains
Authors: Ferrari Luiz F. , Wilkinson Ashley , Cahoon Christian , Ramirez Anna , Rey Charles , Donaldson Gary W. , Taylor Norman E.
Published: June 2023

Background

Chronic postsurgical pain is a poorly recognized outcome of surgery where patients experience pain long after healing from the surgical insult. Descending control of nociception, a phenomenon whereby application of a strong nociceptive stimulus to one part of the body of animals inhibits pain in remote body regions, offers one strategy to identify a propensity to develop chronic postsurgical pain-like behavior. Here, consomic rat panel was used to test the hypothesis that pain persistence is mechanistically linked to ineffective descending control of nociception.

Methods

Male and female Brown Norway, Dahl S, and eight consomic strains (SS-xBN) were used to determine the presence of chronic postsurgical pain-like behaviors by using paw-withdrawal threshold evaluation (von Frey method) in the area adjacent to a hind paw plantar incision. Descending control of nociception was assessed by measuring hind paw-withdrawal thresholds (Randall–Selitto method) after capsaicin (125 µg) injection into a forepaw. Consomic rats were developed by introgressing individual Brown Norway chromosomes on the Dahl S rat genetic background, as Dahl S rats lack preoperative descending control of nociception.

Results

Substitution of several chromosomes from the “pain-resistant” Brown Norway to the “pain-prone” Dahl S/Medical College of Wisconsin reduced mechanical nociceptive sensitivity and increased endogenous pain modulation capacity by differing degrees. Statistical modeling of these data revealed that descending control of nociception is a poor general predictor of the propensity to develop chronic postsurgical pain-like behavior (poor fit for model 1). However, a significant strain-by-descending control of nociception interaction was revealed (model 3, −2*log likelihood; 550.668, −2ll change; 18.093, P = 0.034) with SS-13BN and SS-15BN strains showing a negative descending control of nociception relationship with chronic postsurgical pain-like behavior.

Conclusions

Descending control of nociception poorly predicted which rat strains developed chronic postsurgical pain-like behavior despite controlling for genetic, environmental, and sex differences. Two consomic strains that mimic clinical chronic postsurgical pain criteria and display a strong negative correlation with descending control of nociception were identified, offering novel candidates for future experiments exploring mechanisms that lead to chronic postsurgical pain.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Health Disparities in Ovarian Cancer
Authors: Mei Shirley , Chelmow David , Gecsi Kimberly , Barkley Joel , Barrows Emily , Brooks Rebecca , Huber-Keener Kathryn , Jeudy Myrlene , O'Hara Julia Sage , Burke William
Published: June 2023

Health disparity, defined by the Centers for Disease Control and Prevention (CDC) as “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations,” is seen across multiple diseases. We conducted an evidence review of health disparities and inequities and their mitigation strategies related to ovarian cancer as part of a CDC-sponsored project to develop educational materials for clinicians on the prevention and early diagnosis of gynecologic cancers. Our review found profound disparities in outcomes such as survival, treatment, and stage at diagnosis by factors such as race and ethnicity, insurance, socioeconomic status, and geographic location. We found little direct evidence on mitigation strategies. Studies support equivalent response to equivalent treatment between groups, suggesting that adherence to National Comprehensive Cancer Network guidelines can at least partially mitigate some of the differences.
Executive Summary of the Ovarian Cancer Evidence Review Conference
Authors: Burke William , Barkley Joel , Barrows Emily , Brooks Rebecca , Gecsi Kimberly , Huber-Keener Kathryn , Jeudy Myrlene , Mei Shirley , O’Hara Julia Sage , Chelmow David
Published: June 2023

The Centers for Disease Control and Prevention awarded funding to the American College of Obstetricians and Gynecologists to develop educational materials for clinicians on gynecologic cancers. The American College of Obstetricians and Gynecologists convened a panel of experts in evidence review from the Society for Academic Specialists in General Obstetrics and Gynecology and content experts from the Society of Gynecologic Oncology to review relevant literature, best practices, and existing practice guidelines as a first step toward developing evidence-based educational materials for women's health care clinicians about ovarian cancer. Panel members conducted structured literature reviews, which were then reviewed by other panel members and discussed at a virtual meeting of stakeholder professional and patient advocacy organizations in February 2022. This article is the executive summary of the relevant literature and existing recommendations to guide clinicians in the prevention, early diagnosis, and special considerations of ovarian cancer. Substantive knowledge gaps are noted and summarized to provide guidance for future research.
Perioperative Considerations for Hysterectomy in Second-Trimester Molar Pregnancy
Authors: Applebaum Jeremy , Mulugeta-Gordon Lakeisha , Mokkarala Sameera , Salva Catherine R.
Published: June 2023

BACKGROUND:

Second-trimester complete molar pregnancies are rare. Due to a later presentation, means to reduce surgical and long-term morbidity from hemorrhage, hyperthyroidism, and gestational trophoblastic neoplasia risk should be considered.

CASE:

A 48-year-old woman presented at 17 6/7 weeks of gestation with vaginal bleeding, with a human chorionic gonadotropin (hCG) level of 483,906 milli-international units/mL, biochemical hyperthyroidism, and ultrasonographic suspicion for complete molar pregnancy. The patient received preoperative uterine artery embolization and antithyroid medication before undergoing total abdominal hysterectomy. Her thyroid function and hCG level normalized by 1 week and 69 days postoperatively, respectively.

CONCLUSION:

Uterine artery embolization and hysterectomy may reduce surgical blood loss and lower the risk of malignancy for patients at high risk for gestational trophoblastic neoplasia. Preoperative treatment of hyperthyroidism with gestational trophoblastic disease can reduce morbidity from thyrotoxicosis.
Pain With Differing Insufflation Pressures During Robotic Sacrocolpopexy
Authors: Rustia Gabriella M. , Baracy Michael G. , Khair Emilee , Hagglund Karen H. , Aslam Muhammad Faisal
Published: June 2023

OBJECTIVE:

To evaluate whether decreasing insufflation pressure reduces postoperative pain and opioid use in women undergoing robotic-assisted sacrocolpopexy.

METHODS:

In a single-blinded randomized trial, women with pelvic organ prolapse underwent robotic-assisted sacrocolpopexy at either 12 mm Hg (experimental) or 15 mm Hg (standard) insufflation pressure. The primary outcome was pain rating on a visual analog scale (VAS) on postoperative day 1 within 24 hours of surgery. Secondary outcomes included VAS pain rating at outpatient follow-up, inpatient and outpatient use of opioids, operative time, and estimated blood loss. A margin of 15 mm was considered clinically different on the VAS, and at 80% power, a sample size of at least 64 participants was needed to show significance.

RESULTS:

From April 27, 2021, to May 17, 2022, 80 women were enrolled, with 41 in the experimental group and 39 in the standard group. All participants underwent surgery as planned and attended a 2-week postoperative follow-up. Participants in the experimental group had less pain on postoperative day 1 with median VAS of 17.0 mm (interquartile range 26.0) compared with 29.0 mm (interquartile range 32.0, P=.007) in the standard group. No differences were noted in the secondary outcomes of operative time, estimated blood loss, or length of stay. Participants in the experimental group were noted to use fewer opioids while an inpatient (P=.04) and outpatient (P=.02). In multivariable analyses, lower insufflation pressure and increasing age were negatively associated with postoperative VAS scores.

CONCLUSION:

Lowering insufflation pressure (12 mm Hg) during robotic-assisted sacrocolpopexy safely reduced postoperative pain and opioid use compared with standard pressure (15 mm Hg).

CLINICAL TRIAL REGISTRATION:

ClinialTrials.gov, NCT 04858438.
Predictors and Temporal Trends of Withdrawal of Life-Sustaining Therapy After Acute Stroke in the Florida Stroke Registry
Authors: Alkhachroum Ayham , Zhou Lili , Asdaghi Negar , Gardener Hannah , Ying Hao , Gutierrez Carolina M. , Manolovitz Brian M. , Samano Daniel , Bass Danielle , Foster Dianne , Sur Nicole B. , Rose David Z. , Jameson Angus , Massad Nina , Kottapally Mohan , Merenda Amedeo , Starke Robert M. , O’Phelan Kristine , Romano Jose G. , Claassen Jan , Sacco Ralph L. , Rundek Tatjana
Published: June 2023

OBJECTIVES:

Temporal trends and factors associated with the withdrawal of life-sustaining therapy (WLST) after acute stroke are not well determined.

DESIGN:

Observational study (2008–2021).

SETTING:

Florida Stroke Registry (152 hospitals).

PATIENTS:

Acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) patients.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Importance plots were performed to generate the most predictive factors of WLST. Area under the curve (AUC) for the receiver operating curve were generated for the performance of logistic regression (LR) and random forest (RF) models. Regression analysis was applied to evaluate temporal trends. Among 309,393 AIS patients, 47,485 ICH patients, and 16,694 SAH patients; 9%, 28%, and 19% subsequently had WLST. Patients who had WLST were older (77 vs 70 yr), more women (57% vs 49%), White (76% vs 67%), with greater stroke severity on the National Institutes of Health Stroke Scale greater than or equal to 5 (29% vs 19%), more likely hospitalized in comprehensive stroke centers (52% vs 44%), had Medicare insurance (53% vs 44%), and more likely to have impaired level of consciousness (38% vs 12%). Most predictors associated with the decision to WLST in AIS were age, stroke severity, region, insurance status, center type, race, and level of consciousness (RF AUC of 0.93 and LR AUC of 0.85). Predictors in ICH included age, impaired level of consciousness, region, race, insurance status, center type, and prestroke ambulation status (RF AUC of 0.76 and LR AUC of 0.71). Factors in SAH included age, impaired level of consciousness, region, insurance status, race, and stroke center type (RF AUC of 0.82 and LR AUC of 0.72). Despite a decrease in the rates of early WLST (< 2 d) and mortality, the overall rates of WLST remained stable.

CONCLUSIONS:

In acute hospitalized stroke patients in Florida, factors other than brain injury alone contribute to the decision to WLST. Potential predictors not measured in this study include education, culture, faith and beliefs, and patient/family and physician preferences. The overall rates of WLST have not changed in the last 2 decades.
Evaluation of the Impact of ABCDEF Bundle Compliance Rates on Postintensive Care Syndrome: A Secondary Analysis Study*
Authors: Kawakami Daisuke , Fujitani Shigeki , Koga Hidenobu , Dote Hisashi , Takita Mumon , Takaba Akihiro , Hino Masaaki , Nakamura Michitaka , Irie Hiromasa , Adachi Tomohiro , Shibata Mami , Kataoka Jun , Korenaga Akira , Yamashita Tomoya , Okazaki Tomoya , Okumura Masatoshi , Tsunemitsu Takefumi
Published: June 2023

OBJECTIVES:

This study aimed to examine the association between ABCDEF bundles and long-term postintensive care syndrome (PICS)-related outcomes.

DESIGN:

Secondary analysis of the J-PICS study.

SETTING:

This study was simultaneously conducted in 14 centers and 16 ICUs in Japan between April 1, 2019, and September 30, 2019.

PATIENTS:

Adult ICU patients who were expected to be on a ventilator for at least 48 hours.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Bundle compliance for the last 24 hours was recorded using a checklist at 8:00 am The bundle compliance rate was defined as the 3-day average of the number of bundles performed each day divided by the total number of bundles. The relationship between the bundle compliance rate and PICS prevalence (defined by the 36-item Short Form Physical Component Scale, Mental Component Scale, and Short Memory Questionnaire) was examined. A total of 191 patients were included in this study. Of these, 33 patients (17.3%) died in-hospital and 48 (25.1%) died within 6 months. Of the 96 patients with 6-month outcome data, 61 patients (63.5%) had PICS and 35 (36.5%) were non-PICS. The total bundle compliance rate was 69.8%; the rate was significantly lower in the 6-month mortality group (66.6% vs 71.6%, p = 0.031). Bundle compliance rates in patients with and without PICS were 71.3% and 69.9%, respectively (p = 0.61). After adjusting for confounding variables, bundle compliance rates were not significantly different in the context of PICS prevalence (p = 0.56). A strong negative correlation between the bundle compliance rate and PICS prevalence (r = –0.84, R2
= 0.71, p = 0.035) was observed in high-volume centers.

CONCLUSIONS:

The bundle compliance rate was not associated with PICS prevalence. However, 6-month mortality was lower with a higher bundle compliance rate. A trend toward a lower PICS prevalence was associated with higher bundle compliance in high-volume centers.
Financial Toxicity Following Cancer in a Middle-Income Country with a Pluralistic Health System: Validation of the COST Questionnaire
Authors: Sakti Veni V. , Danaee Mahmoud , Yip Cheng-Har , Bustamam Ros S. A. , Saad Marniza , Gan Gin Gin , Tan Jerome , Lim Yueh Ni , Chong Flora L.T. , Munisamy Murallitharan , Mohd Farid Farahida , Sew Boon Lui , Kong Yek-Ching , Muniandy Nishalini , Bhoo-Pathy Nirmala
Published: June 2023

Background:

Financial toxicity is the outcome of the objective financial burden and subjective financial distress experienced by patients receiving cancer treatment.

Objective:

To validate the English and Malay versions of the COmprehensive Score for financial Toxicity (COST) questionnaire in a multiethnic setting with a pluralistic healthcare system.

Intervention/methods:

A cross-sectional study was conducted on 720 adults with cancer from public and private hospitals across Malaysia. Reliability was estimated using Cronbach’s α for internal consistency. Construct validity was assessed by exploratory factor analysis. Criterion validity was tested using the European Organization for Research and Treatment of Cancer’s Quality of Life Questionnaire.

Results:

Overall, 362 respondents answered the English language questionnaire and 358 answered the Malay version. Both versions achieved high reliability (Cronbach’s α: .91 and 0.96, respectively). Exploratory factor analysis via the parallel analysis method identified a single factor solution with eigenvalues of 6.244 and 6.544, explaining 56.80% and 59.50% of variances, respectively. Low positive correlations and strong negative correlations were observed with global health status and financial difficulty, respectively. Subgroup analyses indicated that both versions performed well across diverse patient groups.

Conclusion:

The English and Malay versions of COST are psychometrically robust in measuring financial toxicity in multiethnic settings with pluralistic health systems and across diverse subgroups of cancer patients with varying clinical characteristics.

Implications for Practice:

The COST tool should be useful in accurately identifying patients with cancer who experience financial toxicity in Malaysian settings and potentially other similar settings.

What is Foundational:

Early identification of patients experiencing financial toxicity using validated tools in oncology practice would enable timely intervention.
Can magnetic resonance imaging differentiate muscle invasion (T2) and lamina propria invasion (T1) urothelial carcinoma of the bladder? A systematic review and meta-analysis of Vesical Imaging-Reporting and Data System accuracy
Authors: Jazayeri Seyed Behzad , Dehghanbanadaki Hojat , Hosseini Mahdie , Taghipour Pourya , Bacchus Michael W. , Di Valerio Elizabeth A. , Sarabchian Elnaz , Balaji K.C. , Bandyk Mark
Published: June 2023

Background

Vesical Imaging-Reporting and Data System (VI-RADS) was developed as a structured reporting tool to anticipate the possibility of muscle invasion. This study is aimed to investigate the diagnostic accuracy of VI-RADS for discriminating T2 from T1 bladder cancer.

Materials and methods

Scopus, Web of Science, PubMed, and Embase were searched on October 4, 2021, for studies with the following characteristics: (1) bladder cancer patient population, (2) VI-RADS as an index test, (3) retransurethral resection of bladder tumor/cystectomy as a reference, and (4) adequate VI-RADS score data for T1 and T2 lesions. The analyses were performed using the binary regression model of MIDAS in Stata.

Results

Six studies with 624 magnetic resonance imaging reports were included. The receiver operating characteristics curve for differentiation of T2 from T1 bladder cancer showed an area under the curve of 0.93 (95% confidence interval [CI], 0.91–0.95) for a VI-RADS ≥3 and 0.75 (95% CI, 0.71–0.79) for a VI-RADS ≥4. A VI-RADS ≥3 showed high sensitivity of 93% (95% CI, 85%–97%), specificity of 61% (95% CI, 30%–86%), positive likelihood ratio of 2.4 (95% CI, 1.1–5.3), and negative likelihood ratio of 0.11 (95% CI, 0.05–0.24). A total of 10.4% of T2 lesions were scored as VI-RADS 2, while 10% of T1 lesions were scored as VI-RADS 4 or 5.

Conclusions

The VI-RADS ≥3 has high accuracy and sensitivity for detecting muscle invasion in borderline populations of T1 or T2 bladder cancer. Thus, the VI-RADS could be a good non-invasive screening test for the detection of T2 urothelial lesions.
Time Trends in Histopathological Findings in Mammaplasty Specimens in a Dutch Academic Pathology Laboratory
Authors: Stutterheim Hannah W. , ter Hoeve Natalie D. , Maarse Wiesje , van der Wall Elsken , van Diest Paul J.
Published: June 2023

Background:

Reduction mammaplasties are often performed at a relatively young age. Necessity of routine pathological investigation of the removed breast tissue to exclude breast cancer has been debated. Past studies have shown 0.05%–4.5% significant findings in reduction specimens, leading to an ongoing debate whether this is cost-effective. There is also no current Dutch guideline on pathological investigation of mammaplasty specimens. Because the incidence of breast cancer is rising, especially among young women, we re-evaluated the yield of routine pathological investigation of mammaplasty specimens over three decades in search of time trends.

Methods:

Reduction specimens from 3430 female patients examined from 1988 to 2021 in the UMC Utrecht were evaluated. Significant findings were defined as those that may lead to more intensive follow-up or surgical intervention.

Results:

Mean age of patients was 39 years. Of the specimens, 67.4% were normal; 28.9% displayed benign changes; 2.7%, benign tumors; 0.3%, premalignant changes; 0.8%, in situ; and 0.1%, invasive cancers. Most patients with significant findings were in their forties (P < 0.001), the youngest patient being 29 years. Significant findings increased from 2016 onward (P = 0.0001), 86.8% found after 2016.

Conclusions:

Over three decades, 1.2% of mammaplasty specimens displayed significant findings on routine pathology examination, with an incidence rising to 2.1% from 2016 onward. The main reason for this recent increase is probably attributable to super-specialization by the pathologists. While awaiting formal cost-effectiveness studies, the frequency of significant findings for now seems to justify routine pathological examination of mammaplasty reduction specimens.
A Single-center Comparison of Unipedicled and Bipedicled Diep Flap Early Outcomes in 98 Patients
Authors: Ahmed Zahra , Ioannidi Lydia , Ghali Shadi , Hamilton Stephen , Shtarbanov Petko , Mosahebi Afshin , Nikkhah Dariush
Published: June 2023

Background:

The deep inferior epigastric perforator (DIEP) flap is the gold standard for autologous breast reconstruction. One or two pedicles may be used. Our study is the first to compare unipedicled and bipedicled DIEP flaps on donor and recipient site outcomes in the same patient cohort.

Methods:

This is a retrospective cohort study comparing DIEP flap outcomes between 2019 and 2022.

Results:

There were 98 patients, categorized differently for recipient or donor site. The recipient groups were unilateral unipedicled (N = 52), bilateral unipedicled (N = 15), and unilateral bipedicled (N = 31), and donor site groups were unipedicled (N = 52) and bipedicled (N = 46, including bilateral unipedicled and unilateral bipedicled). Bipedicled DIEP flaps had 1.15 times greater odds of donor site complication (95% CI, 0.52–2.55). Adjusting for operative time that was longer in bipedicled DIEP flaps (P < 0.001), odds ratio decreased, and there was a lower probability of donor site complication for bipedicled flaps (OR, 0.84; 95% CI, 0.31–2.29). Odds of recipient area complication was not significantly different between groups. Unilateral unipedicled DIEP flaps had significantly higher rates of revisional elective surgery than unilateral bipedicled DIEP flaps (40.4% versus 12.9%; P = 0.029).

Conclusions:

We demonstrate no significant difference in donor site morbidity between unipedicled and bipedicled DIEP flaps. Bipedicled DIEP flaps do have slightly higher rates of donor site morbidity, which can be partly explained by longer operative times. There is no significant difference in recipient site complications, and bipedicled DIEP flaps can reduce rates of further elective surgery.
Aesthetic Units and Zones of Adherence, Relevance to Planning Incisions in Body Contouring Surgery
Authors: Kirwan Laurence
Published: June 2023

Background:

Aesthetic units (AUs) and zones of adherence (ZAs) have been previously noted in the face and torso. A systematic classification of common AUs and ZAs has not been previously described for the torso and extremities. Contour and scars are equally important in obtaining the best result. Therefore, the six principles to consider in body contouring surgery (BCS) are that the resulting scar be anchored at a zone of adhesion; at the interface of AUs; concealed within flexion or extension skin creases, or placed according to conventional usage and experience; positioned on the medial aspect of a limb; hidden when nude, topless, or in a variety of clothing such as one-piece and two-piece swimsuits, crop tops, short sleeves, etc; and positioned to avoid a contracture across a flexion joint crease or a dehiscence across the extension aspect of a joint.

Methods:

Images of male and female massive weight loss (MWL) patients with a history of MWL were reviewed and analyzed.

Results:

AUs and Zas are described and codified. An algorithm is provided to aid in planning incisions for BCS.

Conclusion:

With the increase in BCS after MWL, a classification of AUs and ZAs is considered useful in planning surgery and optimizing the aesthetic result.
Sexual Risk Behavior and Satisfaction Among Men Who Have Sex With Men Living With Detectable HIV Viral Loads: A Nationwide Online Survey in China
Authors: Fu Leiwen , Wang Bingyi , Tian Tian , Zhou Xinyi , Lu Zhen , Sun Yinghui , Zheng Weiran , Gao Yanxiao , Lin Yi-Fan , Li Hui , Zou Huachun
Published: June 2023

Little is known about sexual behavior and satisfaction among men who have sex with men (MSM) with detectable HIV viral loads (VL) in China. This study aims to investigate sexual risk behavior and sexual satisfaction among MSM living with HIV in China, as well as potential predictors. This cross-sectional study was conducted in February 2021 using an anonymous online survey based on WeChat. Data were collected on sociodemographics, sexual behavior, HIV clinical information, sexual satisfaction and mental health. Descriptive statistics, logistic regression and multivariable logistic regression were performed. MSM with detectable HIV VL (VL+) or VL not sure were more likely to report inconsistent condom use, even with HIV-negative/unknown-status regular male partners. Having an HIV-positive regular partner and recreational drug use were positively associated with inconsistent condom use during anal sex among MSM with undetectable VL (VL−). Alcohol use before or during sexual activities was positively associated with inconsistent condom use during anal sex among VL+ or VL not sure MSM. A total of 58.3% of participants reported being sexually satisfied. MSM living with HIV who were currently employed, had experienced anal sex in the prior 6 months, had VL− HIV status, or had more frequent ejaculation during sex/masturbation were more likely to report sexual satisfaction. The development of targeted education and interventions to minimize sexual risk behavior among MSM living with HIV is in dire need. Treating sexual dysfunction and developing a reasonable antiretroviral therapy regimen to achieve viral suppression can help promote sexual satisfaction in MSM living with HIV.
Prevalence, length, and patterns of Anterior Loop among the South Indian population: A comparative study between Panoramic Radiography and Cone Beam Computed Tomography
Authors: Mathew Anju , N Mohan
Published: June 2023

Purpose:

To assess the prevalence, length, and patterns of the anterior loop of the inferior alveolar nerve by panoramic radiography and cone beam computed tomography (CBCT).

Materials and Methodology:

A prospective study was conducted on 300 mental foramen regions by exposing them to panoramic radiography and CBCT scan. Two individual observers evaluated the images to assess the presence of an anterior loop, the mean length of the loop, and the most frequent pattern of the loop in our population.

Result Analysis:

The prevalence of the anterior loop for male patients and female patients by panoramic radiography was 34% and 32% on the right side and 30% and 36% on left side, respectively. By CBCT, the corresponding values were 69% and 72% on the right and left side, respectively, for male patients, and 73% and 81% on the right and left side, for female patients, respectively.

Conclusion:

The results from our study strongly emphasize the need for CBCT imaging before planning for procedures in the mental foramen region because the prevalence, length, and pattern of loop significantly varies with respect to age, sex, and population.
Associations of Nonmotor Symptom Burden, Activities of Daily Living, and Fear of Falling in Parkinson Disease
Authors: Taskin Yilmaz Feride , Celik Selda , Anataca Gulden , Mercan Sakar Emine
Published: June 2023

BACKGROUND: Parkinson disease (PD), a neurodegenerative disease characterized by motor and nonmotor symptoms, can affect the daily activities of individuals. This study was conducted to determine nonmotor symptom burden in patients with PD and to reveal the relationship of nonmotor symptom burden with activities of daily living and fear of falling. METHODS: This cross-sectional and correlational study was carried out with 309 patients given a diagnosis of PD. The data were collected using a personal information form, the Non-Motor Symptoms Scale, the Katz Activities of Daily Living Scale, and the Fear of Falling Questionnaire. RESULTS: Whereas 70.2% of the patients had very high nonmotor symptom severity levels, 33.7% were semidependent or dependent in terms of performing their activities of daily living. The fear of falling was experienced by 32.7% of the patients. A statistically significant inverse relationship was found between the mean Non-Motor Symptoms Scale scores of the patients and their mean Katz Activities of Daily Living Scale and Fear of Falling Questionnaire scores (P < .05). Nonmotor symptom burden independently explained 66% of the total variance in the performance of activities of daily living and 69% of the total variance in fear of falling (P < .01). CONCLUSION: Nonmotor symptom burden in PD patients is a significant determinant for participation in activities of daily living and fear of falling. Nurses should approach patients with PD with a focus not only on assessing motor symptoms but also on assessing nonmotor symptoms.
Pancreatic adenocarcinoma and aging: understanding the menace for better management
Authors: Zhou Tianxing , Yan Jingrui , Hao Jihui , Yu Jun
Published: June 2023

Pancreatic ductal adenocarcinoma (PDAC) is the leading cause of cancer-related death worldwide. As PDAC is more common in older adults and the population is aging, the incidence of pancreatic adenocarcinoma is expected to increase in the coming years. As a result, the mechanism and clinical management of PDAC in the elderly population is receiving more attention. This review will discuss age-related morphological and pathological changes, clinical management, surgery and adjuvant therapies, and molecular changes in elderly PDAC patients. More research is needed to clarify molecular mechanisms and develop new prevention and treatment strategies for PDAC in elderly patients.
Using the Alluvial diagram to display variable characteristics for COVID-19 patients and research achievements on the topic of COVID-19, epidemiology, pathogenesis, and vaccine (CEPV): Bibliometric analysis
Authors: Yen Po-Tsung , Chien Tsair-Wei , Chou Willy , Tsai Kang-Ting
Published: June 2023

Background:

An Alluvial diagram illustrates the flow of values from one set to another. Edges (or links/connections) are the connections between nodes (or actors/ vertices). There has been an increase in the use of Alluvial deposits in medical research in recent years. However, there was no illustration of such research on the way to draw the Alluvial for the readers. Our objective was to demonstrate how to draw the Alluvial in Microsoft Excel by using 2 examples, including variable characteristics for COVID-19 patients and research achievements (RAs) on the topic of COVID-19, epidemiology, pathogenesis, and vaccine (CEPV), and provide an easy and friendly method of drawing the Alluvial in MS Excel.

Methods:

Blood samples were collected and analyzed from 485 infected individuals in Wuhan, China. An operational decision tree and 2 Alluvial diagrams were shown to be capable of identifying variable characteristics in COVID-19 patients. A second example is the 100 top-cited articles downloaded from the Web of Science core collection (WoSCC) on the CEPV topic. On the Alluvial diagram, the mean citations (=citations/publications) and x-index were used to identify the top 5 members with the highest RAs in each entity (country, institute, journal, and research area). Two examples (i.e., blood samples taken from 485 infected individuals in Wuhan, China, and 100 top-cited articles on the CEPV topic) were illustrated and compared with traditional visualizations without flow relationships between nodes.

Results:

The top members in entities with the x-index are U Arab Emirates (242), Jama-J. Am. Med. Assoc. (27.18), Lancet (58.34), San Francisco Va Med (178), and Chaolin Huang (189) in countries, institutes, departments, and authors, respectively. The most cited article with 1315 citations was written by Huang and his colleagues and published by Lancet in 2021.

Conclusion:

This study generates several Alluvial diagrams as demonstrations. The tutorial material and MP4 video provided in the Excel module allow readers to draw the Alluvial on their own in an easy and friendly manner.
Multiple system atrophy with oculomotor abnormalities as a prominent manifestation: A case series
Authors: Wei Yuanxiao , Chen Ju , Lu Cancan , Jiang Yijing , Liu Zhiqiang , Zhang Wenzhao , Fang Liqun
Published: June 2023

Rationale:

Multiple system atrophy (MSA) is a group of adult-onset sporadic neurodegenerative diseases, mainly classified as MSA-C and MSA-P types. Due to the diversity of clinical symptoms, diagnosis faces a significant challenge. In the present case, we report a patient with isolated vertigo as the first presentation and abnormalities of the oculomotor system as the characteristic manifestations.

Case concern:

A 64-year-old male had dizziness for 1 year, aggravated for 4 months, with accompanying symptoms of unsteady walking. Physical examination revealed spontaneous nystagmus, abnormal ataxic movements, and a broad basal gait. Video nystagmography revealed saccade intrusions and macrosaccadic oscillations, and opsoclonus. Magnetic resonance imaging (MRI) was unremarkable early, and positron emission tomography-computed tomography (PET-CT) announced a reduction in the volume of the cerebellum and brainstem.

Diagnosis:

The diagnosis of the possibility of MSA type-C, peripheral neuropathy, hypertension, and lacunar cerebral infarction was performed.

Conclusion:

Atypical early clinical presentation may lead to delays, and identifying the critical problem through the patient simple clinical status requires long-term clinical experience and various ancillary examination tools.
Is the serum level of survivin, an antiapoptotic protein, a potential predictive and prognostic biomarker in metastatic pancreatic cancer?
Authors: Demirci Nebi Serkan , Çavdar Eyyüp , Erdem Gokmen Umut , Hatipoglu Engin , Celik Emir , Sezer Sevilay , Yolcu Ahmet , Dogan Mutlu , Seber Erdogan Selcuk
Published: June 2023

In the present study, we aimed to assess the association between the serum survivin level and overall survival and treatment response rates in metastatic pancreatic cancer (MPC). Serum samples were prospectively collected from 41 patients with newly diagnosed MPC patients and 41 healthy individuals (control group) to assess the survivin levels. The median survivin level was 136.2 ng/mL in patients with MPC and 52 ng/mL in healthy individuals (P = .028). Patients were divided into low- and high-survivin groups according to the baseline median survivin level. Patients with a high serum survivin level compared with a low serum survivin level had shorter median progression-free survival (2.39 vs 7.06 months; P = .008, respectively) and overall survival (3.74 vs 9.52 months; P = .026, respectively). Patients with higher serum survivin levels had significantly worse response rates (P = .007). The baseline high level of serum survivin in patients with MPC may be associated with treatment resistance and poor prognosis. A confirmation will be needed for these results in future large multicenter prospective studies.
An atypical erectile dysfunction patient with infertility treated with penile prosthesis implantation and testicular epididymal sperm aspiration (TESA)-intracytoplasmic sperm injection (ICSI): A case report
Authors: Lin Mengyuan , Wang Honghua , Wang Yan , Jiang Shi-Wen
Published: June 2023

Rationale:

Erectile dysfunction (ED) is common in middle-aged and elderly men, affecting more than 100 million males worldwide. Most ED cases can be attributed to organic and/or psychological factors. Here we report an atypical ED case with no clear manifestation fitting the diagnosis for recognized types of ED.

Patient concerns:

The 35-year-old male is unable to have normal erection since puberty, and unable to complete intercourse with his wife. He had no history of trauma, surgery or psychiatric/psychological disease. The patient has a normal male karyotype. There is no significant finding in physical examination, nocturnal penile tumescence test, and ultrasound measurement of penis vascular functions. The serum levels of major hormones are all in normal ranges.

Diagnoses:

Atypical ED, psychogenic ED not excluded; infertility.

Interventions:

Oral phosphodiesterase inhibitors Tadalafil (20 mg, BIW) or Sildenafil (50 mg, BIW) had no effect in this patient. Penile prosthesis implantation helped the patient to acquire normal sexual life, but did solve the ejaculation failure and infertility. Motile sperms were obtained by testicular epididymal sperm aspiration under the guidance of ultrasound, and intracytoplasmic sperm injection was performed with occytes retrieved from his wife.

Outcomes:

The patient sexual life was significantly improved after penile prosthesis implantation; the patient wife is currently in the first trimester of pregnancy as the result of in vitro fertilization.

Conclusions:

The no response to phosphodiesterase type 5 inhibitors (PDE5) treatment may suggest an impediment of PDE5-related pharmacological pathways or the presence of defect/injury in the neural system. This special case raises a question if some patients with persistent ED may have similar manifestations and can be treated with the same procedures.
Aloe vera gel for prevention of chemotherapy-induced hyperpigmentation: Four case reports
Authors: Chiu Chia-Chi , Hsiao Yi-Wen , Wen Yu-Chuan , Chang Tsung-Yen , Chen Shih-Hsiang , Jaing Tang-Her
Published: June 2023

Rationale:

This study aimed to evaluate the efficacy of topical application of Aloe vera gel in preventing chemotherapy-induced hyperpigmentation (CIH). CIH is a common side effect of chemotherapy that causes skin irritation, redness, and itching. Aloe vera has been studied for its potential use in treating radiation-induced dermatitis, which may help alleviate some of the symptoms associated with this condition.

Patient concerns:

In this study, 4 children requiring curative chemotherapy were prospectively enrolled and treated with Aloe vera gel.

Diagnosis:

Acute skin reactions were monitored and classified according to the Common Terminology Criteria for Adverse Events Grading Scale.

Interventions:

Patients were asked to use the gel on one-half of the body field twice daily from the beginning of treatment until 4 weeks after the completion of chemotherapy, with no medication to be used on the other half.

Outcomes:

The results indicate that applying Aloe vera gel may reduce the visibility of hyperpigmentation at subsequent time points. The most important observation was that the continued application of Aloe vera gel 4 weeks after the completion of chemotherapy was effective in reducing the grading of CIH.

Lessons:

These effects highlight the potential of Aloe vera gel as a topical onconutraceutical treatment for CIH.