bluuebunny/crossref_metadata_2025 huggingface dataset:
CDKN2A inhibited ferroptosis through activating JAK2/STAT3 pathway to modulate cisplatin resistance in cervical squamous cell carcinoma
Authors: Yong Xiang , Zhang Yanling , Tang Heng , Hu Huaiyuan , Song Rui , Wu Qiang
Published: May 2024

Cervical squamous cell carcinoma (CESC) is a significant threat to women’s health. Resistance to cisplatin (DDP), a common treatment, hinders the therapeutic efficacy. Understanding the molecular basis of DDP resistance in CESC is imperative. Cyclin-dependent kinase inhibitor 2A (CDKN2A) expression was evaluated through quantitative real-time-PCR and western blot in clinical samples from 30 CESC patients and human cervical epithelial cells and CESC cell lines (SiHa, C33A, and Caski). It was also evaluated through bioinformatics analysis in Timer, Ualcan, and GEPIA database. Cell viability was detected by CCK-8. Apoptosis was detected by Calcein AM/PI assay. Lipid reactive oxygen species (ROS), malondialdehyde, glutathione, Fe2+, and iron level were detected by kits. Protein level of JAK2, STAT3, p-JAK2, p-STAT3, ACSL4, GPX4, SLC7A11, and FTL were detected by western blot. In CESC, elevated CDKN2A expression was observed. Cisplatin exhibited a dual effect, inhibiting cell proliferation and inducing ferroptosis in CESC. CDKN2A knockdown in a cisplatin-resistant cell line suppressed proliferation and induced ferroptosis. Moreover, CDKN2A was identified as an inhibitor of erastin-induced ferroptosis. Additionally, targeting the JAK2/STAT3 pathway enhanced ferroptosis in cisplatin-resistant cells. CDKN2A could inhibit ferroptosis in CESC through activating JAK2/STAT3 pathway to modulate cisplatin resistance.
Noninvasive Positive Pressure Ventilation Use and In-Hospital Cardiac Arrest in Bronchiolitis
Authors: Shepard Lindsay N. , Mehta Sanjiv , Graham Kathryn , Kienzle Martha , O’Halloran Amanda , Yehya Nadir , Morgan Ryan W. , Keim Garrett P.
Published: May 2024

IMPORTANCE:

A recent study showed an association between high hospital-level noninvasive positive pressure ventilation (NIPPV) use and in-hospital cardiac arrest (IHCA) in children with bronchiolitis.

OBJECTIVES:

We aimed to determine if patient-level exposure to NIPPV in children with bronchiolitis was associated with IHCA.

DESIGN, SETTING AND PARTICIPANTS:

Retrospective cohort study at a single-center quaternary PICU in North America including children with International Classification of Diseases primary or secondary diagnoses of bronchiolitis in the Virtual Pediatric Systems database.

MAIN OUTCOMES AND MEASURES:

The primary exposure was NIPPV and the primary outcome was IHCA.

MEASUREMENTS AND MAIN RESULTS:

Of 4698 eligible ICU admissions with bronchiolitis diagnoses, IHCA occurred in 1.2% (57/4698). At IHCA onset, invasive mechanical ventilation (IMV) was the most frequent level of respiratory support (65%, 37/57), with 12% (7/57) receiving NIPPV. Patients with IHCA had higher Pediatric Risk of Mortality-III scores (3 [0–8] vs. 0 [0–2]; p < 0.001), more frequently had a complex chronic condition (94.7% vs. 46.2%; p < 0.001), and had higher mortality (21.1% vs. 1.0%; p < 0.001) compared with patients without IHCA. Return of spontaneous circulation (ROSC) was achieved in 93% (53/57) of IHCAs; 79% (45/57) survived to hospital discharge. All seven children without chronic medical conditions and with active bronchiolitis symptoms at the time of IHCA achieved ROSC, and 86% (6/7) survived to discharge. In multivariable analysis restricted to patients receiving NIPPV or IMV, NIPPV exposure was associated with lower odds of IHCA (adjusted odds ratio [aOR], 0.07; 95% CI, 0.03–0.18) compared with IMV. In secondary analysis evaluating categorical respiratory support in all patients, compared with IMV, NIPPV was associated with lower odds of IHCA (aOR, 0.35; 95% CI, 0.14–0.87), whereas no difference was found for minimal respiratory support (none/nasal cannula/humidified high-flow nasal cannula [aOR, 0.56; 95% CI, 0.23–1.36]).

CONCLUSIONS AND RELEVANCE:

Cardiac arrest in children with bronchiolitis is uncommon, occurring in 1.2% of bronchiolitis ICU admissions. NIPPV use in children with bronchiolitis was associated with lower odds of IHCA.
National Emergency Tele-Critical Care in a Pandemic: Barriers and Solutions
Authors: Pamplin Jeremy C. , Gray Brooke , Quinn Matthew T. , Little Jeanette R. , Colombo Christopher J. , Subramanian Sanjay , Farmer Joseph C. , Ries Michael , Scott Benjamin ,   for the Governance Stakeholder Working Group and National Emergency Tele-Critical Care Network Team Participants
Published: May 2024

The COVID-19 pandemic caused tremendous disruption to the U.S. healthcare system and nearly crippled some hospitals during large patient surges. Limited ICU beds across the country further exacerbated these challenges. Telemedicine, specifically tele-critical care (TCC), can expand a hospital’s clinical capabilities through remote expertise and increase capacity by offloading some monitoring to remote teams. Unfortunately, the rapid deployment of telemedicine, especially TCC, is constrained by multiple barriers. In the summer of 2020, to support the National Emergency Tele-Critical Care Network (NETCCN) deployment, more than 50 national leaders in applying telemedicine technologies to critical care assembled to provide their opinions about barriers to NETCCN implementation and strategies to overcome them. Through consensus, these experts developed white papers that formed the basis of this article. Herein, the authors share their experience and propose multiple solutions to barriers presented by laws, local policies and cultures, and individual perspectives according to a minimum, better, best paradigm for TCC delivery in the setting of a national disaster. Cross-state licensure and local privileging of virtual experts were identified as the most significant barriers to rapid deployment of services, whereas refining the model of TCC to achieve the best outcomes and defining the best financial model is the most significant for long-term success. Ultimately, we conclude that a rapidly deployable national telemedicine response system is achievable.
Exploring breast cancer screening fear through a psychosocial lens
Authors: Burugu Vikas , Salvatore Mary
Published: May 2024

Breast cancer screening is crucial for early detection and treatment. Yet, underutilization persists due to various psychosocial factors. This manuscript delves into the multifaceted fears that hinder screening adherence. The literature provides a framework categorizing breast cancer screening fears into generalized cancer fear, fear of screening components, and fear of screening outcomes. In this review, we explore fear of screening components (concerns regarding radiation, discomfort, and pain) and fear of screening outcomes (disability and mortality apprehension, treatment fears, obligation anxiety, and financial concerns) as undesirable, and potentially addressable, aspects of breast cancer screening fear. False-positive results exacerbate these anxieties, prolonging distress and impacting patients’ lives beyond the screening process. Addressing these concerns requires reframing current screening approaches to prioritize patient comfort, cultural sensitivity, and accessibility. To address current psychosocial challenges in breast cancer screening, this manuscript advocates for modifying breast cancer screening methods to improve adherence and patient well-being.
Acupuncture at five Zang-shu and Ge-shu for bipolar depression: study protocol for a randomized controlled pilot trial
Authors: Chen Pei , Liu Yue , Yuan Haining , Wang Di , Jin Xin , Zhang Lei , Yan Kaijuan , Guo Yumeng , Li Jing , Wang Fei , Sun Weishuang , Yang Yang
Published: May 2024

Background:

Bipolar disorder is a very common, often misdiagnosed mental disorder strongly associated with comorbidity, disability, and premature mortality. Bipolar depression (i.e., depressive episode in bipolar disorder) is poorly responsive to available treatments. Acupuncture at five Zang-shu and Ge-shu, a prescription from Dr. Leting Wang, is a popular therapy for depression in China. Its effectiveness and safety for bipolar depression is yet to be verified by clinical study.

Methods/design:

The study is a single-center, prospective, randomized controlled trial involving 72 patients diagnosed with bipolar depression. Participants will be randomized either to the study group or the control group in a 1:1 ratio. All participants will receive mood stabilizer therapy. In addition, the study group will receive acupuncture therapy at five Zang-shu and Ge-shu, three times per week. The control group will orally take the antidepressant bupropion. Observation and intervention will last for 8 consecutive weeks. Outcome measurements include Hamilton Depression Rating Scale-17 (HAMD-17), Hamilton Anxiety Rating Scale (HAMA), Clinical Global Impression Scale (CGI), Young Manic Rating Scale (YMRS), Treatment Emergent Symptom Scale (TESS), serum levels of anti-inflammatory cytokines (IL-4, IL-10, TGF-β), pro-inflammatory cytokines (IL-1β, IL-6, TNF-α), brain-derived neurotrophic factor (BDNF) and C-Reactive Protein (CRP). Assessments will be conducted at baseline, 1st, 2nd, 4th and 8th week after randomization. Safety assessments will be performed throughout the study.

Discussion:

The results of this study are expected to verify the effectiveness and safety of acupuncture at five Zang-shu and Ge-shu for bipolar depression, and explore its therapeutic mechanisms from the point of anti- inflammation.
The cognition of standards and standardization concepts and reflection on standardization work of traditional Chinese medicine specialty
Authors: Tang Xudong , Bian Liqun
Published: May 2024

In the journey towards the modernization and internationalization of Traditional Chinese Medicine (TCM), standards and standardization emerge as indispensable foundational elements and carry strategic significance. By introducing the concepts of standards and standardization, this article emphasizes their essential roles as the base of modern industry and the core of modernization efforts. It revisits the development plans and national strategies for TCM, highlighting the pivotal role of standardization in the inheritance and innovation within the TCM discipline. The standardization of TCM specialties is underscored for its critical function in both inheriting and innovating, as well as enhancing the international competitiveness of TCM. Through discussing the specific practices in standardizing the TCM specialty of spleen and stomach diseases, the article advocates for strengthening top-level design and advancing the systematic construction of the TCM specialty standards system. It suggests employing a variety of methods, including expert consultations and literature research, to refine the standardization processes of TCM clinical diagnosis and treatment techniques. This approach ensures that the work on specialty standardization not only meets practical needs but also possesses foresight and scientific validity.
Targeting the sympathetic nervous system with the selective imidazoline receptor agonist moxonidine for the management of hypertension: an international position statement
Authors: Schlaich Markus P. , Tsioufis Konstantinos , Taddei Stefano , Ferri Claudio , Cooper Mark , Sindone Andrew , Borghi Claudio , Parissis John , Marketou Maria , Vintila Ana Maria , Farcas Anca , Kiuchi Marcio G. , Chandrappa Shukrath
Published: May 2024

Hypertension is often linked with metabolic risk factors that share common pathophysiological pathways. Despite wide-spread availability of multiple drug classes, optimal blood pressure (BP) control remains challenging. Increased central sympathetic outflow is frequently neglected as a critical regulator of both circulatory and metabolic pathways and often remains unopposed therapeutically. Selective imidazoline receptor agonists (SIRAs) effectively reduce BP with a favorable side effect profile compared with older centrally acting antihypertensive drugs. Hard outcome data in hypertension, such as prevention of stroke, heart and kidney diseases, are not available with SIRAs. However, in direct comparisons, SIRAs were as effective as angiotensin-converting enzyme inhibitors, β-blockers, calcium channel blockers, and diuretics in lowering BP. Other beneficial effects on metabolic parameters in hypertensive patients with concomitant overweight and obesity have been documented with SIRAs. Here we review the existing evidence on the safety and efficacy of moxonidine, a widely available SIRA, compared with common antihypertensive agents and provide a consensus position statement based on inputs from 12 experts from Europe and Australia on SIRAs in hypertension management.
Finger pulse plethysmography predicts gestational hypertension, preeclampsia and gestational diabetes
Authors: Shahrbabaki Sobhan Salari , Liu Xiao , Baumert Mathias
Published: May 2024

Background:

Pregnancy complications related to hypertension can affect both mother and newborn. Pulse wave attenuation (PWA) captured through fingertip photoplethysmography (PPG) provide valuable insights into maternal acute hemodynamic and autonomic vascular function. Here, we quantify the nocturnal dynamics of PWA during early pregnancy and assess their association with the development of gestational hypertension, preeclampsia and gestational diabetes.

Methods:

PWA dynamics were assessed on overnight polysomnography-derived PPG signals from a cohort of 2714 pregnant women (mean age: 26.8 ± 5.5 years) enrolled in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b). We determined the average duration (PWAduration) and depth (PWAdepth) of PWA events in all women.

Results:

Odds ratio (OR) analysis-adjusted common confounders indicates that an average PWAduration greater than 8.74 s was associated with the increased risk of gestational hypertension [OR = 1.75 (1.27–2.39), P < 0.001]. Similarly, average PWAdepth greater than 1.19 was associated with an increased risk of preeclampsia [OR = 1.53 (1.01–2.33), P = 0.045] and gestational diabetes [OR = 1.66 (1.01–2.73), P = 0.044].

Conclusion:

PWA attenuation dynamics during early pregnancy predict the risk of developing gestational hypertension and diabetes condition for women in their later trimesters. Potentially obtainable from smart wearable consumer devices, PWA analysis offers a low-cost, accessible and scalable marker that can enhance the management of pregnancy-induced cardiometabolic issues.
Outcomes of Phacoemulsification With or Without Kahook Dual Blade Goniotomy for Glaucoma Patients With Cataract
Authors: Radwan Loubna , El Jalbout Jana Dib , Trad Khalid , Radwan Lama , El Zein Lulwa , Brearley Ann , Jiang Ziou , Chanbour Wassef
Published: May 2024

Précis:

This meta-analysis examines the comparative efficacy of phacoemulsification with and without Kahook Dual Blade Goniotomy in individuals with glaucoma and cataract, aiming to elucidate optimal surgical approaches for coexisting conditions.

Purpose:

The purpose of this current study is to compare the effect of combining Kahook Dual Blade (KDB) goniotomy with phacoemulsification versus phacoemulsification alone on intraocular pressure (IOP) and medication reduction in patients with glaucoma and cataract.

Methods:

We conducted a systematic review and meta-analysis utilizing computer databases, including Embase (OVID), MEDLINE (OVID and PubMed), CINHAL (EBSCO), and the Cochrane Library (Wiley). We included studies examining the IOP-lowering effect of KDB goniotomy combined with phacoemulsification and studies that examined the IOP-lowering effect of phacoemulsification alone in patients with open angle glaucoma or ocular hypertension. The mean reduction of IOP and the reduction in topical glaucoma eye drops after surgery were determined.

Results:

A total of 26 studies were included, reporting on 1659 patients, 684 patients underwent phacoemulsification alone, and 975 underwent combined phacoemulsification and KDB goniotomy. A 9.62% IOP reduction from baseline occurred following phacoemulsification as a solo procedure compared with 22.74% following combined KDB goniotomy with phacoemulsification. Similarly, the combination of the procedures caused a significant drop in the mean number of glaucoma eye drops used [mean reduction=1.35, 95% CI (1.08, 1.61)] compared with phacoemulsification alone [mean reduction=0.36, 95% CI (0.06, 0.66)]. Funnel plots suggested the absence of publication bias.

Conclusions:

Both phacoemulsification alone or combined with KDB goniotomy result in a significant decrease in post-op IOP and topical glaucoma eye drops. The combination of these 2 procedures outperforms phacoemulsification alone in terms of both parameters.
Correlates of markers of dyssynchrony in patients with STEMI and multivessel disease: an analysis from the IAEA SPECT STEMI trial
Authors: Peix Amalia , Jimenez-Heffernan Amelia , Devasenapathy Niveditha , Sobic-Saranovic Dragana , Vitola Joao , Giubbini Raffaele , Rodella Carlo , Haque Saif-ul , Alexanderson Rosas Erick , Ozkan Elgin , Keng Yung Jih Felix , Dondi Maurizio , Paez Diana , Karthikeyan Ganesan
Published: May 2024

Background

In this substudy of the Value of Gated-SPECT MPI for Ischemia- Guided PCI of non-culprit vessels in STEMI Patients with Multi vessel Disease after primary PCI trial after primary PCI we aim to assess if infarct size affects conventional measures of dyssynchrony at rest. Additionally, we explore if there is an independent correlation of stress-inducible ischemia with dyssynchrony at rest.

Methods

The 48 patients with imaging at randomization were analyzed. Gated-single-photon emission computed tomography (SPECT) MPI with vasodilator stress and technetium-99m-labeled tracers was performed. The phase histogram bandwidth (HBW), phase SD, and entropy were obtained with the QGS software. Correlation between dyssynchrony at rest and infarct size and inducible ischemia was performed using the Spearman test.

Results

According to normal database limits dyssynchrony parameters at rest were abnormal for men. In women only HBW was abnormal. Correlation between the summed rest score with dyssynchrony was significant only for entropy (P = 0.035). No correlation was observed for dyssynchrony and stress-induced ischemia.

Conclusion

Entropy, as a measure of dyssynchrony, has potential in the assessment of patients with STEMI and multivessel disease after primary PCI. Smaller residual myocardial scars in PCI-reperfused patients with STEMI may contribute to the lack of correlation between dyssynchrony at rest and infarct size and stress-induced ischemia, respectively.
Severe Unexplained Iron Deficiency Anemia in Children: High Yield of Upper Gastrointestinal Endoscopy Regardless of Gastrointestinal Symptoms
Authors: Yuran Nufar , Ben-Ami Tal , Kori Michal
Published: May 2024

In this retrospective study spanning 2016 to 2022, we aimed to evaluate the diagnostic utility of upper gastrointestinal endoscopy (UGE) in children under 18 years presenting with severe unexplained iron deficiency anemia (IDA), defined as microcytic anemia of hemoglobin ≤7 g/dL with low ferritin levels. Out of 106 children hospitalized for severe anemia, 29 had unexplained IDA (mean hemoglobin level of 6.2 [3.2 to 6.9] gr/dL), and 25 of them underwent UGE. The mean age was 10.7 ± 3.9 years, with 76% being female. Ten children (40%) had gastrointestinal (GI) symptoms at presentation. The cause of IDA was found in 18 (72%) of 25 children who underwent UGE, of whom 12 were without GI symptoms. Gastric nodularity, erosions, or polyps were observed in 68%, and gastritis was evident in 72% based on histopathology. Helicobacter pylori was found in 50% of those with gastritis. Follow-up showed normalized hemoglobin levels in 92% of cases, with only 2 children requiring repeat iron therapy. Our findings underscore the importance of incorporating UGE into the diagnostic investigation of severe unexplained IDA in children, irrespective of the presence of GI symptoms.
Ruxolitinib Monotherapy for a Child With HAVCR2 Gene Mutation Associated Subcutaneous Panniculitis-Like T-Cell Lymphoma: A Case Report
Authors: Zhang Gege , Zhou Chunju , Wei Ang , Zhang Rui , Zhao Yunze , Ma Honghao , Lian Hongyun , Wang Dong , Wang Tianyou
Published: May 2024

Background:

The occurrence of hemophagocytic lymphohistiocytosis (HLH) in patients with subcutaneous panniculitis-like T-cell lymphoma (SPTCL) may be due to HAVCR2 gene mutation, leading to T-cell immunoglobulin and mucin domain-containing molecule 3 deficiency, T-cell and macrophage activation, and proinflammatory cytokine production.

Observation:

We report a patient with SPTCL and HLH for whom ruxolitinib, used as a novel treatment, showed notable therapeutic effects.

Conclusions:

Remission of both HAVCR2 mutation-induced high inflammatory characteristics and significant symptoms post-ruxolitinib administration suggested that patients with SPTCL and HLH may not represent typical lymphoma cases. Ruxolitinib, with its relatively low toxic side effects, can provide favorable outcomes.
Evaluation of hepatic injury in chronic hepatitis B and C using APRI and FIB-4 indices compared to fibroscan results
Authors: Najafi Narges , Razavi Alireza , Jafarpour Hamed , Raei Maedeh , Azizi Zahra , Davoodi Lotfollah , Abdollahi Amirsaleh , Frouzanian Mehran
Published: May 2024

Background:

Hepatitis B (HBV) and hepatitis C viruses (HCV) are significant causes of liver disease worldwide. Liver fibrosis (LF) is a complication of chronic liver damage caused by HBV and HCV due to our limited knowledge comparing the diagnostic performance of platelet to aspartate aminotransferase ratio index (APRI) and fibrosis-4 (FIB-4) index with fibroscan.

Methods:

This study evaluated liver damage in HBV and HCV using APRI, FIB-4, and fibroscan indices. This retrospective cohort descriptive-analytical study was conducted on patients with HBV and HCV. This study uses laboratory results and imaging to investigate liver damage in chronic HBV and HCV patients. APRI and FIB-4 were computed based on laboratory results.

Results:

A total of 185 patients (82 hepatitis B and 103 hepatitis C) were included in the study. Thirteen patients had liver cirrhosis. There was no statistically significant difference between the fibroscan results in the two groups (P=0.99). The HBV group’s mean APRI and FIB-4 were lower than HCV, but no significant difference was observed (P>0.05). Our results in HBV and HCV patients showed that APRI and FIB-4 accomplished well anticipating cirrhosis with an area under the receiver operating characteristic curve (AUC) of 0.771–0.845 and 0.871–0.910, respectively.

Conclusion:

Fibroscan is a powerful tool superior to APRI and FIB-4 in predicting LF and cirrhosis. Nevertheless, APRI and FIB-4 are inexpensive and non-invasive indicators with acceptable efficacy in predicting advanced fibrosis or cirrhosis. However, these two measures are not reliable in low-grade fibrosis.
Code Crimson: A Postpartum Hemorrhage Bundled Intervention Quality Improvement Project
Authors: Modri Stefanie , Sharma Mehar , Quigley Elizabeth , Anca Raluca , O’Hanlon Brianna , Pyle Elizabeth , Hussey Alicia , Hamm Rebecca , Nagpal Mohika , Trout Kimberly K.
Published: May 2024

Background:

Postpartum hemorrhage (PPH) is a leading cause of maternity mortality in the United States. The Code Crimson project aimed to enhance PPH management by implementing a standardized intervention bundle to mitigate morbidity and mortality associated with PPH.

Local Problem:

At a large Philadelphia tertiary hospital, health disparities existed for severe maternal morbidity and mortality, and PPH was a significant factor.

Methods:

A quality improvement design, using Plan-Do-Study-Act cycles and interrupted time series analysis, was undertaken.

Interventions:

The Code Crimson project implemented a standardized bundle to manage PPH, including blood product administration and massive transfusion protocol activation.

Results:

After implementing the Code Crimson bundle, there was a significant decrease in blood product use (P < .001), with minor reductions in packed red blood cell administration over 4 units and mean blood loss.

Conclusions:

The Code Crimson bundle effectively reduced blood product utilization for PPH treatment.
An Age Group Comparison of Concurrent Hospice Care
Authors: Svynarenko Radion , Cozad Melanie J. , Lindley Lisa C.
Published: May 2024

This study aimed to examine the cost-effectiveness of concurrent hospice care compared with standard care among pediatric patients of different age groups. Using a national Medicaid database of 18 152 pediatric patients enrolled in hospice care between 2011 and 2013, this study calculated and analyzed incremental cost-effectiveness ratios (ICERs) for concurrent care versus standard hospice care for children of 4 age categories: <1 year, 1 to 5 years, 6 to 14 years, and 15 to 20 years. The results indicated that the total Medicaid cost of hospice care was $3229 per patient per month (PPPM; SD, $8709) for those younger than 1 year, $4793 PPPM (SD, $8178) for those aged 1 to 5 years, $5411 PPPM (SD, $7456) for those aged 6 to 14 years, and $5625 PPPM (SD, $11459) for those aged 15 to 20 years. Incremental cost-effectiveness ratio values across all age groups showed that children enrolled in concurrent care had fewer live discharges but at a higher Medicaid cost of care as compared with those enrolled in standard hospice care. Concurrent hospice care was the most cost-effective in the age groups of <1 year and 1 to 5 years, with ICERs equal to $45 (95% confidence interval [CI], $23-$66) and $49 (95% CI, $8-$76), respectively. For the other older age groups, benefits of enrollment in concurrent care came at a much higher cost: in the age group of 6 to 14 years, ICER was equal to $217 (95% CI, $129-$217), and in the age group of 15 to 20 years, it was $107 (95% CI, $82-$183). Concurrent hospice is an effective way to reduce live discharges but has a higher total Medicaid cost than standard hospice care.
Evaluation of the effect of intraoperative tropisetron on postoperative rebound pain after brachial plexus block: a randomized controlled trial
Authors: Liu Junli , Liu Mingming , Shi Shengnan , Jiang Fei , Zhang Ye , Guo Jing , Gong Xingrui
Published: May 2024

Introduction:

Postoperative rebound pain after peripheral nerve block increases patient suffering and delays recovery after surgery.

Objectives:

We tested whether the 5HT-3 receptor antagonist and α7nAChR agonist tropisetron could prevent postoperative rebound pain.

Methods:

A total of 115 patients were randomized to receive 5-mg/5-mL tropisetron or the same volume of normal saline. Pain intensity was measured with the numerical rating scale of pain (NRS). Rebound pain was defined as a change from mild pain (NRS ≤ 3) measured in the postanesthesia care unit to severe pain (NRS ≥ 7) within 24 hours after peripheral nerve blockade. Logistic regression was used to identify relevant factors associated with postoperative rebound pain.

Results:

Tropisetron did not affect the NRS score or the incidence of rebound pain after peripheral nerve block. Logistic regression revealed that preoperative pain, bone surgery, and length of incision were risk factors for postoperative rebound pain, and patient-controlled analgesia was protective against postoperative rebound pain.

Conclusion:

Tropisetron does not affect the incidence of rebound pain after peripheral nerve block. Patients at high risk of postoperative rebound pain should be identified for appropriate management. Registration site: www.chictr.org.cn (ChiCTR2300069994).
The Role of Pediatric Nurses During Preventable Adverse Event Disclosure: A Scoping Review
Authors: Sexton Jessica R. , Kelly-Weeder Susan
Published: May 2024

Objectives

Preventable adverse events (PAEs) occur across the healthcare spectrum; and, unfortunately, errors, adverse events, and PAEs are common in pediatric care. Historically, the role of disclosure of PAEs to patients and their families occurred between the dyad of physician and patient, with physicians assuming the responsibility of disclosure. In recent years, a trend toward a multidisciplinary team-based approach has emerged in some institutions, yet the role of pediatric nurses within the team disclosing a PAE is not fully understood. Given the unique relationship between pediatric nurses and their patients and their families, it is essential to understand does the literature tell us about the role of pediatric nurses during PAE disclosure?

Methods

The Arksey and O’Malley scoping review method guided this study protocol and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews framework guided reporting.

Results

The final sample included five articles for synthesis: none reported or described a specific role for pediatric nurses during PAE disclosure.

Conclusions

There is a gap in the literature on the role of pediatric nurses during PAE disclosure. Two themes emerged from this review: the use of a team-based approach to disclosure, and the need to provide emotional support to the pediatric patient and their family. There is a need for additional investigation into the role of pediatric nurses as part of a team-based disclosure process and how pediatric nurses currently provide, or desire to provide, emotional support to the patient and their family.
Primary Care Organizational Support for Nurse Practitioner Practice and Emotional Health Care Delivery
Authors: Turi Eleanor , Schlak Amelia , Trexler Jamie , Courtwright Suzanne , Flandrick Kathleen , Liu Jianfang , Poghosyan Lusine
Published: May 2024

Objectives

Nurse practitioners (NPs) are key to delivery of primary care services. However, poor organizational support for independent NP practice, such as lack of access to clinic resources, may lead to prioritizing patient physical health over emotional health. We investigated the relationship between organizational support for independent NP practice and emotional health care delivery.

Methods

This was a secondary analysis of cross-sectional survey data collected from 397 NPs in 2017. We measured organizational support for independent NP practice using the independent practice and support subscale of the NP Primary Care Organizational Climate Questionnaire. Emotional health care delivery was measured by asking NPs how frequently they addressed emotional concerns of patients. We utilized multilevel mixed effects linear regression models, adjusting for NP and practice covariates.

Results

Controlling for NP age, gender, marital status, race, and ethnicity, along with practice setting and size, as the independent practice and support score increased, NPs reported addressing emotional concerns of patients more frequently (beta = 0.34, 95% confidence interval = 0.02–0.66, P = 0.04). This indicates that as organizations provided more support for independent NP practice, NPs were able to more frequently address emotional concerns of patients.

Conclusions

Organizational support for independent NP practice is associated with addressing emotional concerns of patients. To support NP practice, primary care organizations should ensure that NPs manage patients independently and have access to ancillary staff and support for care management.
Morphological Changes of the Temporomandibular Joint and Masseter Muscle After Mandibular Angle Osteotomy
Authors: Huang Yuanliang , Liu Fei , Lu Jianjian , Teng Li
Published: May 2024

Mandibular angle osteotomy with outer cortex grinding is an effective cosmetic procedure for correcting square faces. However, morphological changes in the mandible may also cause temporomandibular joint (TMJ) disorders. This retrospective study aimed to investigate the morphological stabilization of the TMJ and changes in masseter muscle thickness after mandibular angle osteotomy to evaluate the safety of the procedure. Data from patients who underwent mandibular angle osteotomy with outer cortex grinding between January 2016 and January 2019 were retrospectively reviewed. Preoperative and long-term follow-up (~1 y) computed tomography data were collected from these patients, and morphological changes in the TMJ and masseter muscle were analyzed. The results from the computed tomography data showed that the condylar length and condylar height were significantly reduced 1 year after the operation (P < 0.05). In addition, the morphology of the TMJ was stable, and the distance between the mandibular condyle and the glenoid fossa did not change significantly. No significant difference was observed in masseter muscle thickness before and after the operation. After mandibular angle osteotomy with outer cortex grinding, the length and height of the mandibular condyle were functionally restored without any disorders of the TMJ. Moreover, the masseter muscle exhibited stable function. In conclusion, the procedure is safe for occlusal function and suitable for popularization.
Do Anthropometric Measurements of The Orbital Region Differ Between Healthy Children and Children With Attention Deficit Hyperactivity Disorder?
Authors: Karadağ Mehmet , Arslanoğlu Sami , Hangül Zehra , Bahşi İlhan
Published: May 2024

Objective:

The aim of this study is to investigate whether there may be differences in the measurements of the orbital region between healthy children and children with attention deficit hyperactivity disorder (ADHD).

Methods:

In this study, the orbital region measurements of 310 children, including 130 ADHD children and 180 healthy children aged 7 to 11 years, were analyzed. For this analysis, anterior view photographs of these individuals were used. For both sides, endocanthion (en), exocanthion (ex), and pupil (p) were determined in these photographs. A total of 5 distances (ex-ex, en-en, ex-en for the right side, ex-en for the left side and p-p) were analyzed using these points.

Results:

In both sexes, no statistically significant difference was observed between the 2 groups in all 6 parameters analyzed.

Conclusion:

Although it was concluded that there was no difference in orbital measurements between healthy children and children with ADHD in this study, it was thought that a definite conclusion could not be reached because the cases examined belonged to a single center. Therefore, it is thought that multicenter studies in which more individuals are evaluated are needed.
Differential Effects of Ascites and Hepatic Encephalopathy on Waitlist Mortality in Liver Transplantation by MELD 3.0
Authors: Lee Brian T. , Chen Nathan T. , Fong Tse-Ling , Dodge Jennifer L.
Published: May 2024

Background.

MELD 3.0 introduces changes to address waitlist disparities for liver transplant (LT) candidates. Ascites and hepatic encephalopathy (HE) are important milestones in the natural history of cirrhosis regardless of the Model for End-Stage Liver Disease (MELD) score. We aim to assess the impact of ascites and HE and its interaction with MELD 3.0 on waitlist mortality.

Methods.

This is a retrospective study of patients listed for LT in the Organ Procurement and Transplantation Network database from 2016 to 2021. The primary outcome was waitlist mortality (death/delisting for too sick to LT). Ascites/HE were classified as moderate ascites without moderate HE (mAscites), moderate HE without moderate ascites (mHE), both moderate ascites/HE (mBoth), and neither. MELD 3.0 scores were categorized as <20, 20–29, 30–39, and ≥40.

Results.

Of 39 025 candidates, 29% had mAscites, 3% mHE, and 8% mBoth. One-year waitlist mortality was 30%, 38%, and 47%, respectively, compared with 17% (all P < 0.001) for those with neither. In multivariable Cox regression, the adjusted risk of waitlist mortality associated with mAscites (versus neither) was a hazard ratio (HR) of 1.76 (95% confidence interval [CI], 1.55-2.00) when the MELD 3.0 score was <20, significantly higher than when the MELD 3.0 score was 20–29 (HR 1.40; 95% CI, 1.27-1.54), 30–39 (HR 1.19; 95% CI, 1.04-1.35), and ≥40 (HR 1.14; 95% CI, 0.91-1.43, interaction P < 0.05 for all). A similar pattern was observed by MELD 3.0 for both moderate ascites/HE.

Conclusions.

The presence of moderate ascites alone, or combined with moderate HE, not only increases the risk of waitlist mortality but also has a differential effect by MELD 3.0, especially at lower MELD scores. Earlier strategies addressing this group and improving treatment plans or access to LT regardless of MELD remain needed.
Recruitment of a Diverse Community-based Older Adult Cohort for a Longitudinal Aging Study
Authors: Jacobsen Erin , Lucas Heather , Moran Catherine , Dixon Reverend Gloria , Ganguli Mary
Published: May 2024

Introduction:

Enrolling individuals from underrepresented ethnoracial groups in aging research is often a challenge.

Methods:

We sought a diverse sample of older adults from a small-town area for a longitudinal aging study. We employed an intensive community engagement approach encompassing a range of recruitment strategies.

Results:

Over 4 years a steady trickle of individuals, 66% self-identifying as Black, signed up for study information; the proportion of those who eventually enroll in the study has been rising each year, from 68% to 94%. Community events, word-of-mouth referrals, and mailed postcards brought in the most contacts. The highest percentage of contacts who ultimately enrolled were from postcards, flyers, and word-of-mouth. Significantly more word-of-mouth referrals were endorsed by Black individuals than White and by Black men than other race/sex groups.

Conclusions:

We have had some success in building relationships and trust with the local community, enrolling Black study participants in a proportion equal to their representation in the target community using a variety of recruitment methods. Patience, immersion in the community, and partnerships with key community members alongside traditional advertisements, and the utilization of study participants as recruiters are critical to designing optimal, targeted, recruitment strategies.
Meta-Analysis of White Matter Hyperintensity Volume Differences Between APOE ε4 Carriers and Noncarriers
Authors: Stipho Faissal , Malek-Ahmadi Michael
Published: May 2024

Several studies have suggested that white matter hyperintensity volume (WMHV) is increased among apolipoprotein E (APOE) ε4 carriers while others have reported contradictory findings. Although APOE ε4 carriage is associated with greater AD pathology, it remains unclear whether cerebrovascular damage is also associated with APOE ε4 carriage. The aim of this meta-analysis was to determine whether WMHV is associated with APOE ε4 carrier status. 12 studies that were included yielded a total sample size of 16,738 adult subjects (ε4 carrier n = 4,721; ε4 noncarrier n = 12,017). There were no significant differences in WMHV between ε4 carriers and noncarriers (Hedge’s g = 0.07; 95% CI (−0.01 to 0.15), P = 0.09). Subgroup analysis of community-based studies (n = 8) indicated a small effect size where ε4 carriers had greater WMHV relative to noncarriers (Hedge’s g = 0.09 95% CI (0.02 to 0.16), P = 0.008). Among clinic-based studies (n = 3) there was no significant difference in WMHV by APOE ε4 carrier status (Hedge’s g = −0.09, 95% CI (−0.60 to 0.41), P = 0.70). Observed APOE ε4-associated WMHV differences may be context-dependent and may also be confounded by a lack of standardization for WMHV segmentation.
Lack of Concordance Between Abbreviated Injury Scale and American Association for the Surgery of Trauma Organ Injury Scale in Patients with High-Grade Solid Organ Injury
Authors: Santos Jeffrey , Kunz Shelby , Grigorian Areg , Park Stephen , Tabarsi Emiliano , Matsushima Kazuhide , Penaloza-Villalobos Liz , Luo-Owen Xian , Mukherjee Kaushik , Alvarez Claudia , Nahmias Jeffry
Published: May 2024

BACKGROUND:

The Abbreviated Injury Scale (AIS) is widely used for body region-specific injury severity. The American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) provides organ-specific injury severity but is not included in trauma databases. Previous researchers have used AIS as a surrogate for OIS. This study aims to assess AIS-abdomen concordance with AAST-OIS grade for liver and spleen injuries, hypothesizing concordance in terms of severity (grade of OIS and AIS) and patient outcomes.

STUDY DESIGN:

This retrospective study (July 2020 to June 2022) was performed at 3 trauma centers. Adult trauma patients with AAST-OIS grade III to V liver and spleen injury were included. AAST-OIS grade for each organ was compared with AIS-abdomen by evaluating the percentage of AAST-OIS grade correlating with each AIS score as well as rates of operative intervention for these injuries. Analysis was performed with chi-square tests and univariate analysis.

RESULTS:

Of 472 patients, 274 had liver injuries and 205 had spleen injuries grades III to V. AAST-OIS grade III to V liver injuries had concordances rates of 85.5%, 71%, and 90.9% with corresponding AIS 3 to 5 scores. AAST-OIS grade III to V spleen injuries had concordances rates of 89.7%, 87.8%, and 87.3%, respectively. There was a statistical lack of concordance for both liver and spleen injuries (both p < 0.001). Additionally, there were higher rates of operative intervention for AAST-OIS grade IV and V liver injuries and grade III and V spleen injuries vs corresponding AIS scores (p < 0.05).

CONCLUSIONS:

AIS should not be used interchangeably with OIS due to lack of concordance. AAST-OIS should be included in trauma databases to facilitate improved organ injury research and quality improvement projects.
Haemolymph transfusions transfer heritable learned novel odour preferences to naive larvae of
Bicyclus anynana
butterflies
Authors: Gowri V. , Monteiro Antonia
Published: May 2024

The mechanisms whereby environmental experiences of parents are transmitted to their offspring to impact their behaviour and fitness are poorly understood. Previously, we showed that naive
Bicyclus anynana
butterfly larvae, whose parents fed on a normal plant feed but coated with a novel odour, inherited an acquired preference towards that odour, which had initially elicited avoidance in the naive parents. Here, we performed simple haemolymph transfusions from odour-fed and control-fed larvae to naive larval recipients. We found that larvae injected with haemolymph from odour-fed donors stopped avoiding the novel odour, and their naive offspring preferred the odour more, compared to the offspring of larvae injected with control haemolymph. These results indicate that factors in the haemolymph, potentially the odour molecule itself, play an important role in odour learning and preference transmission across generations. Furthermore, this mechanism of odour preference inheritance, mediated by the haemolymph, bypasses the peripheral odour-sensing mechanisms taking place in the antennae, mouthparts or legs, and may mediate food plant switching and diversification in Lepidoptera or more broadly across insects.
A refined magnetic pulse treatment method for magnetic navigation experiments with adequate sham control: a case study on free-flying songbirds
Authors: Karwinkel Thiemo , Winklhofer Michael , Allenstein Dario , Brust Vera , Christoph Paula , Holland Richard A. , Hüppop Ommo , Steen Jan , Bairlein Franz , Schmaljohann Heiko
Published: May 2024

Migratory songbirds may navigate by extracting positional information from the geomagnetic field, potentially with a magnetic-particle-based receptor. Previous studies assessed this hypothesis experimentally by exposing birds to a strong but brief magnetic pulse aimed at remagnetizing the particles and evoking an altered behaviour. Critically, such studies were not ideally designed because they lacked an adequate sham treatment controlling for the induced electric field that is fundamentally associated with a magnetic pulse. Consequently, we designed a sham-controlled magnetic-pulse experiment, with sham and treatment pulse producing a similar induced electric field, while limiting the sham magnetic field to a value that is deemed insufficient to remagnetize particles. We tested this novel approach by pulsing more than 250 wild, migrating European robins (
Erithacus rubecula
) during two autumn seasons. After pulsing them, five traits of free-flight migratory behaviour were observed, but no effect of the pulse could be found. Notably, one of the traits, the migratory motivation of adults, was significantly affected in only one of the two study years. Considering the problem of reproducing experiments with wild animals, we recommend a multi-year approach encompassing large sample size, blinded design and built-in sham control to obtain future insights into the role of magnetic-particle-based magnetoreception in bird navigation.
The benefits of ‘slow’ development: towards a best practice for sustainable technical infrastructure through the Davy Notebooks Project
Authors: Blickhan Samantha , Bird Eleanor , Lacey Andrew , Wolf Alexis
Published: May 2024

In this article we consider technical development and its role in digital humanities research efforts. We critique the concept that ‘novel’ development is crucial for innovation and tie this thinking to the corporatization of higher education. We suggest instead that sustainable technical development practices require a combination of need, creativity and reuse of existing technical infrastructure. First, we present our theory of ‘slow’ development based on this need-driven approach, then demonstrate how this theory can be applied to digital humanities research efforts using the Davy Notebooks Project as a case study. By tracing the history of this multi-phase, public crowdsourcing project and exposing the decision-making process behind its technical development, we demonstrate the promise and possibility of the ‘slow’ method proposed. When read in conjunction with the other essays in this special issue, we hope that this article will demonstrate how digital humanities methods and technical infrastructure can support and sustain traditional modes of scholarship, and the importance of applying the same careful approach to technical development that is applied to research methods more broadly.
Towards algorithm auditing: managing legal, ethical and technological risks of AI, ML and associated algorithms
Authors: Koshiyama Adriano , Kazim Emre , Treleaven Philip , Rai Pete , Szpruch Lukasz , Pavey Giles , Ahamat Ghazi , Leutner Franziska , Goebel Randy , Knight Andrew , Adams Janet , Hitrova Christina , Barnett Jeremy , Nachev Parashkev , Barber David , Chamorro-Premuzic Tomas , Klemmer Konstantin , Gregorovic Miro , Khan Shakeel , Lomas Elizabeth , Hilliard Airlie , Chatterjee Siddhant
Published: May 2024

­Business reliance on algorithms is becoming ubiquitous, and companies are increasingly concerned about their algorithms causing major financial or reputational damage. High-profile cases include Google’s AI algorithm for photo classification mistakenly labelling a black couple as gorillas in 2015 (Gebru 2020 In
The Oxford handbook of ethics of AI
, pp. 251–269), Microsoft’s AI chatbot Tay that spread racist, sexist and antisemitic speech on Twitter (now X) (Wolf
et al
. 2017
ACM Sigcas Comput. Soc
.
47
, 54–64 (doi:
10.1145/3144592.3144598
)), and Amazon’s AI recruiting tool being scrapped after showing bias against women. In response, governments are legislating and imposing bans, regulators fining companies and the judiciary discussing potentially making algorithms artificial ‘persons’ in law. As with financial audits, governments, business and society will require algorithm audits; formal assurance that algorithms are legal, ethical and safe. A new industry is envisaged: Auditing and Assurance of Algorithms (cf. data privacy), with the remit to professionalize and industrialize AI, ML and associated algorithms. The stakeholders range from those working on policy/regulation to industry practitioners and developers. We also anticipate the nature and scope of the auditing levels and framework presented will inform those interested in systems of governance and compliance with regulation/standards. Our goal in this article is to survey the key areas necessary to perform auditing and assurance and instigate the debate in this novel area of research and practice.