bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationships between Type 1 interferon signatures and clinical features of the new-onset lupus patients in Japan
Authors: Shirahama Yuri , Hashimoto Aki , Ono Nobuyuki , Takeyama Yukiko , Maruyama Akihito , Inoue Takuya , Tada Yoshifumi , Niiro Hiroaki
Published: January 2023

Objectives

The objective of the study is to investigate the relationships between Type 1 interferon (T1-IFN) signatures and clinical characteristics of lupus patients.

Methods

We examined 49 new-onset lupus patients who were diagnosed between 1999 and 2017. The patients treated with >10 mg of prednisolone or hydroxychloroquine were excluded from this study. Serum T1-IFN signatures were revealed by a functional reporter assay and standardized by recombinant IFN-α. Patient backgrounds, clinical findings, and treatments were retrospectively extracted from their electrical medical records. Clinical data were also available, including SLE Disease Activity Index of SLE patients on admission.

Results

T1-IFN signatures of lupus patients closely correlated with lupus disease activities, such as SLE Disease Activity Index-2K, white blood cell, C3 levels, and the titre of double-strand DNA antibody. We found fever and acute lupus dermatitis closely associated with T1-IFN signature.

Conclusions

In lupus patients, fever and acute lupus dermatitis are good indicators of a strong T1-IFN signature.
Causes and consequences of endogenous hypoxia on growth and metabolism of developing maize kernels
Authors: Langer Matthias , Hilo Alexander , Guan Jiahn-Chou , Koch Karen E , Xiao Hui , Verboven Pieter , Gündel Andre , Wagner Steffen , Ortleb Stefan , Radchuk Volodymyr , Mayer Simon , Nicolai Bart , Borisjuk Ljudmilla , Rolletschek Hardy
Published: January 2023

Maize (Zea mays) kernels are the largest cereal grains, and their endosperm is severely oxygen deficient during grain fill. The causes, dynamics, and mechanisms of acclimation to hypoxia are minimally understood. Here, we demonstrate that hypoxia develops in the small, growing endosperm, but not the nucellus, and becomes the standard state, regardless of diverse structural and genetic perturbations in modern maize (B73, popcorn, sweet corn), mutants (sweet4c, glossy6, waxy), and non-domesticated wild relatives (teosintes and Tripsacum species). We also uncovered an interconnected void space at the chalazal pericarp, providing superior oxygen supply to the placental tissues and basal endosperm transfer layer. Modeling indicated a very high diffusion resistance inside the endosperm, which, together with internal oxygen consumption, could generate steep oxygen gradients at the endosperm surface. Manipulation of oxygen supply induced reciprocal shifts in gene expression implicated in controlling mitochondrial functions (23.6 kDa Heat-Shock Protein, Voltage-Dependent Anion Channel 2) and multiple signaling pathways (core hypoxia genes, cyclic nucleotide metabolism, ethylene synthesis). Metabolite profiling revealed oxygen-dependent shifts in mitochondrial pathways, ascorbate metabolism, starch synthesis, and auxin degradation. Long-term elevated oxygen supply enhanced the rate of kernel development. Altogether, evidence here supports a mechanistic framework for the establishment of and acclimation to hypoxia in the maize endosperm.
Dysbiosis of gut microbiota, a potential mediator of bile acid compositions, and prevalence of hand synovitis: a community-based study
Authors: Jiang Ting , Yang Zidan , Zhang Yuqing , Zhang Weiya , Doherty Michael , Li Hui , Yang Tuo , Yang Yuanheng , Li Jiatian , Wang Yuqing , Zeng Chao , Lei Guanghua , Wei Jie
Published: January 2023

Objectives

Hand synovitis, a potentially modifiable pathological lesion, is common and associated with pain and hand OA; nevertheless, its pathogenesis remains uncertain. This study investigated the relationship between gut microbiota dysbiosis and hand synovitis prevalence and evaluated whether bile acids mediate the association.

Methods

Participants were derived from a community-based observational study. Synovitis in each hand joint was assessed using US. Gut microbiota was evaluated using 16S ribosomal RNA amplicon sequencing on faeces, and plasma bile acids were measured by HPLC mass spectrometry. We examined the relationship between gut microbiota dysbiosis and hand synovitis prevalence, as well as the extent to which bile acids were involved in the association.

Results

Among 1336 participants (mean age: 63.2 years; women: 58.8%), 18.3% had prevalent hand synovitis (unilateral in 13.6% and bilateral in 4.7%). β-diversity, but not α-diversity, of gut microbiota was significantly associated with prevalent hand synovitis. Higher relative abundance of the genus Prevotella and lower relative abundance of the genus Blautia were significantly associated with the prevalence of hand synovitis. Similar associations were also observed for laterality and the number of joints affected by hand synovitis. The association between Prevotella and hand synovitis was partially mediated through its effect on tauroursodeoxycholic acid and glycoursodeoxycholic acid, the mediation proportions being 25.7% and 21.6%, respectively.

Conclusion

Our findings suggest that gut microbiota dysbiosis is associated with the prevalence of hand synovitis. Such an association appears to be partially mediated by plasma bile acids.
Familial risk of seropositive rheumatoid arthritis and interaction with smoking: a population-based cohort study
Authors: Kim Hyun Jung , Swan Heather , Kazmi Sayada Zartasha , Hong Gahwi , Kim Young Shin , Choi Seeun , Kang Taeuk , Cha Jaewoo , Eom Jungmin , Hann Hoo Jae , Choi In Ah , Ahn Hyeong Sik
Published: January 2023

Objectives

We evaluated the familial risk of seropositive rheumatoid arthritis (RA) and examined interactions between family history and smoking.

Methods

Using the National Health Insurance and Health Screening Program databases, which include information on familial relationships and lifestyle factors, we identified 5 524 403 individuals with first-degree relatives (FDRs) from 2002–2018. We calculated familial risk using hazard ratios (HRs) with 95% CIs which compare the risk of individuals with and without affected FDRs. Interactions between smoking and family history were assessed on an additive scale using the relative excess risk due to interaction (RERI).

Results

Individuals with affected FDR had 4.52-fold (95% CI 3.98, 5.12) increased risk of disease compared with those with unaffected FDR. Familial risk adjusted for lifestyle factors decreased slightly (HR 4.49), suggesting that a genetic contribution is the predominant driver in the familial aggregation of RA. Smoking was associated with an increased risk of disease that was more pronounced among heavy (HR 1.92 95% CI 1.70, 2.18) compared with moderate (HR 1.15 95% CI 1.04, 1.28) smoking. In the interaction analysis, the risk associated with the combined effect of smoking and family history was higher than the sum of their individual effects, though statistically non-significant (RERI 1.30 95% CI ‒0.92, 3.51). Heavy smokers with a positive family history showed a prominent interaction (RERI 4.13 95% CI ‒0.88, 9.13) which exceeded moderate smokers (RERI 0.61 95% CI ‒1.90, 3.13), suggesting a dose-response interaction pattern.

Conclusion

Our findings indicate the possibility of an interaction between RA-associated genes and smoking.
The leukotriene B4/BLT1‐dependent neutrophil accumulation exacerbates immune complex‐mediated glomerulonephritis
Authors: Shioda Ryotaro , Jo‐Watanabe Airi , Okuno Toshiaki , Saeki Kazuko , Nakayama Maiko , Suzuki Yusuke , Yokomizo Takehiko
Published: January 2023

Crescent formation is the most important pathological finding that defines the prognosis of nephritis. Although neutrophils are known to play an important role in the progression of crescentic glomerulonephritis, such as anti‐neutrophil cytoplasmic antibody (ANCA)‐associated glomerulonephritis, the key chemoattractant for neutrophils in ANCA‐associated glomerulonephritis has not been identified. Here, we demonstrate that a lipid chemoattractant, leukotriene B4 (LTB4), and its receptor BLT1 are primarily involved in disease pathogenesis in a mouse model of immune complex‐mediated crescentic glomerulonephritis. Circulating neutrophils accumulated into glomeruli within 1 h after disease onset, which was accompanied by LTB4 accumulation in the kidney cortex, leading to kidney injury. LTB4 was produced by cross‐linking of Fc gamma receptors on neutrophils. Mice deficient in BLT1 or LTB4 biosynthesis exhibited suppressed initial neutrophil infiltration and subsequent thrombotic glomerulonephritis and renal fibrosis. Depletion of neutrophils before, but not after, disease onset prevented proteinuria and kidney injury, indicating the essential role of neutrophils in the early phase of glomerulonephritis. Administration of a BLT1 antagonist before and after disease onset almost completely suppressed induction of glomerulonephritis. Finally, we found that the glomeruli from patients with ANCA‐associated glomerulonephritis contained more BLT1‐positive cells than glomeruli from patients with other etiologies. Taken together, the LTB4‐BLT1 axis is the key driver of neutrophilic glomerular inflammation, and will be a novel therapeutic target for the crescentic glomerulonephritis.
Facilitators and Barriers to the Use of Outcome Measures by Certified Lymphedema Therapists
Authors: Doubblestein David Aaron , Spinelli Bryan A. , Goldberg Allon , Larson Cathy A. , Yorke Amy M.
Published: January 2023

Background:

Various outcome measures (OMs) have been used with individuals with breast cancer–related lymphedema (BCRL). There have not been studies investigating the facilitators and barriers to the use of OMs by certified lymphedema therapists (CLTs) on BCRL. The purposes of this study was to (1) identify facilitators and barriers for use of OMs reported by CLTs and (2) investigate the association of personal and professional characteristics of CLTs and their knowledge or beliefs about OMs.

Methods:

Cross-sectional online survey research design. Electronic surveys were distributed to CLTs from various institutions. Data from 70 physical therapists and 41 occupational therapists were analyzed. Point-biserial correlations examined associations and logistic regression examined predictors to OMs facilitators and barriers.

Results:

Certified lymphedema therapists agreed that OMs help direct a plan of care (90.1%), improve quality of care (76.6%), and determine the efficacy of their intervention on BCRL (72.7%). Certified lymphedema therapists reported difficulty knowing the best OM to choose due to numerous options (67.3%). Barriers for OMs included lack of knowledge and time, availability in workplace, and personal preferences. Characteristics associated with barriers and facilitators were few and poorly correlated.

Conclusion:

Certified lymphedema therapists agree on the benefits of and to the use of OMs, however, physical therapist CLTs may value the use of OMs less than occupational therapists. Certified lymphedema therapists experience barriers to use of OMs related to lack of knowledge and implementation skills. Further guidance is needed in selecting OMs for breast cancer survivors with BCRL to reduce barriers to their use.
Interview Without Harm: Reimagining Medical Training’s Financially and Environmentally Costly Interview Practices
Authors: Hampshire Karly , Shirley Hugh , Teherani Arianne
Published: January 2023

The looming threat of climate change urgently calls for reimagining unsustainable systems and practices, including academia’s culture of emissions-intensive travel. Given that medical educators are uniquely invested in the future of the trainees they represent, this reimagination can and should begin with medical education. Making significant reforms to the application process has historically been challenging, but the COVID-19 pandemic catalyzed an abrupt shift from in-person to virtual interviews for medical school, residency, and fellowship. Programs and applicants alike demonstrated resilience, innovation, and satisfaction in adapting to virtual interviews during 2 full application cycles. This restructuring has prompted consideration of the necessity of environmentally costly, expensive, and time-consuming cross-country travel for single-day interviews. However, evolving conversations about the future of medical training interviews have not prioritized environmental impact, despite the sizeable historical emissions generated by interview-related travel and the incompatibility between ecological damage and population health. Beyond environmental impact, virtual interviews are more equitable, with significantly fewer financial costs, and they are more efficient, requiring less time off from school or work. Many concerns associated with virtual interviews, including interview inflation and limited applicant exposure to programs and their surrounding areas, can be addressed via creative and structural solutions, such as interview caps and in-person second-look programs. The medical training interview process underwent a forced restructuring due to the unprecedented disruption caused by COVID-19. This moment presents a strategic inflection point for medical education leadership to build on the momentum and permanently transform the process by focusing on sustainability and equity.
Lower Hounsfield Units and Severe Multifidus Sarcopenia Are Independent Predictors of Increased Risk for Proximal Junctional Kyphosis and Failure Following Thoracolumbar Fusion
Authors: Pinter Zachariah W. , Mikula Anthony L. , Townsley Sarah E. , Salmons IV Harold I. , Lakomkin Nikita , Michalopoulos Giorgos D. , Nassr Ahmad , Freedman Brett A. , Bydon Mohamad , Fogelson Jeremy , Sebastian Arjun S. , Elder Benjamin D.
Published: January 2023

Study Design.

Retrospective cohort study.

Objective.

The purpose of the present study was to assess the impact of sarcopenia on the development of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) following thoracolumbar spine fusion surgery using opportunistic evaluation of paraspinal fatty degeneration on preoperative magnetic resonance imaging.

Summary of Background Data.

While paraspinal sarcopenia has been shown to have detrimental consequences following posterior cervicothoracic fusions, the impact of paraspinal sarcopenia on PJK and PJF following thoracolumbar spine fusion surgery remains unknown.

Materials and Methods.

We performed a retrospective review of patients who underwent posterior spine fusion surgery that extended caudally to the pelvis and terminated cranially between T10 and L2 between 2010 and 2017. The cohort was divided into three groups: (1) patients without PJK or PJF, (2) patients with PJK but no PJF, and (3) patients with PJF. Univariate and multivariate analyses were performed to determine risk factors for the development of proximal junctional complications.

Results.

We identified 150 patients for inclusion in this study. Mean Hounsfield Units at the upper instrumented vertebra (UIV) was 148.3±34.5 in the cohort of patients without PJK or PJF, which was substantially higher than values recorded in the PJK (117.8±41.9) and PJF (118.8±41.8) subgroups (P<0.001). Severe multifidus sarcopenia was identified at a much higher rate in the subgroups of patients who developed PJK (76.0%) and PJF (78.9%) than in the subgroup of patients who developed neither PJK nor PJF (34.0%;P<0.001). Multivariate analysis demonstrated both low HU at the UIV and moderate-severe multifidus sarcopenia to be risk factors for the development of PJK and PJF.

Conclusion.

The results of this study suggest severe paraspinal sarcopenia and diminished bone density at the UIV impart an increased risk of developing PJK and PJF, while markers of systemic frailty such as modified Frailty Index and Charlson Comorbidity Index are not associated with an increased risk of these complications.

Level of Evidence.

III.
Implementation and Utilization of a Web-Based Departmental Annual Faculty Review Program
Authors: Mueller Stephanie K. , Pascal Christina , Spiers John , Seely Ellen W.
Published: January 2023

Supporting faculty in their professional development is a central mission of academic medical centers (AMCs), assisted by routine assessment of faculty development. However, AMCs face barriers to standard faculty assessment, particularly among large departments with diverse faculty roles. We report on the development, implementation, and utilization of a standardized, web-based faculty annual career review (FACR) process deployed within the Department of Medicine at a large AMC, composed of 22 divisions and 1400 faculty. The FACR process was developed to achieve the following goals: Creation of a trackable review of professional goals and barriers to professional development; provide longitudinal faculty reflection on professional growth; and provide data to identify faculty development needs to target initiatives. The FACR was initiated in 2008. We provide specific case examples of utilization of the FACR data for targeted faculty development initiatives, including (1) division benchmarking; (2) targeting career opportunities to individual faculty members; and (3) longitudinal data analysis of 5-year trends of FACR response, including subanalysis by gender, to target faculty development initiatives across the DOM. In summary, we demonstrate successful development, implementation, and utilization of a web-based standard faculty annual review program within a large AMC that allows for systematic evaluation and reflection of professional development by faculty members and their supervisors and allows for data collection and analysis to help target faculty development initiatives.
Identification of Vaccine Effects When Exposure Status Is Unknown
Authors: Stensrud Mats J. , Smith Louisa
Published: January 2023

Results from randomized controlled trials (RCTs) help determine vaccination strategies and related public health policies. However, defining and identifying estimands that can guide policies in infectious disease settings is difficult, even in an RCT. The effects of vaccination critically depend on characteristics of the population of interest, such as the prevalence of infection, the number of vaccinated, and social behaviors. To mitigate the dependence on such characteristics, estimands, and study designs, that require conditioning or intervening on exposure to the infectious agent have been advocated. But a fundamental problem for both RCTs and observational studies is that exposure status is often unavailable or difficult to measure, which has made it impossible to apply existing methodology to study vaccine effects that account for exposure status. In this study, we present new results on this type of vaccine effects. Under plausible conditions, we show that point identification of certain relative effects is possible even when the exposure status is unknown. Furthermore, we derive sharp bounds on the corresponding absolute effects. We apply these results to estimate the effects of the ChAdOx1 nCoV-19 vaccine on SARS-CoV-2 disease (COVID-19) conditional on postvaccine exposure to the virus, using data from a large RCT.
An umbrella systematic review of the effect of physical exercise on mental health of women in menopause
Authors: Fausto Danielly Y. , Leitão Alice E. , Silveira Juliana , Martins Julia B. B. , Dominski Fábio H. , Guimarães Adriana C. A.
Published: January 2023

Importance

The menopausal transition has been related to worsening mental health. The literature also points out that being physically active during menopause is associated with a favorable effect on climacteric symptoms, specifically on psychological aspects.

Objectives

The aims of the study are to analyze the effects of physical activity on mental health during menopause through an umbrella review and to evaluate the quality of the included Systematic Reviews and meta-analyses (MAs).

Evidence Review

A MeaSurement Tool to Assess Systematic Reviews was used to evaluate the methodological quality of the included studies and the Grading of Recommendations Assessment, Development and Evaluation was applied to assess the level of the evidence of the results. In addition, the effect size of the revised meta-analyses (MAs) was calculated.

Findings

A total of 9 systematic reviews/MAs were included, published between 2014 and 2020. In the A MeaSurement Tool to Assess Systematic Reviews methodological quality assessment, 8 studies were classified as “high quality” and 1 as “low quality.” In terms of quality of the evidence for each result through the Grading of Recommendations Assessment, Development and Evaluation classification, approximately 75% of the studies were classified as “moderate quality,” 22.2% as “high quality,” and 22.2% as “low quality,” with the greatest bias concerning the high heterogeneity of the included studies. In addition, the studies showed low overlap. Despite the high heterogeneity, we can highlight the importance of the practice of physical activity by women in menopause, to prevent and/or reduce problems related to mental health.

Conclusions and Relevance

There was a positive effect of the interventions on depression, however, with no difference between durations (short or long). Regarding stress, the interventions applied did not show a positive effect. The studies that investigated depression linked to anxiety presented conflicting results.
The effect of Cornus mas fruit extract on vasomotor symptoms and sex hormones in postmenopausal women: a randomized, double-blind, clinical trial
Authors: Rimaz Shahnaz , Rahideh Seyedeh Tayebeh , Abolghasemi Jamileh , Jazayeri Shima , Jamshidi Sanaz , Motevalian Manijeh , Solaymani-Dodaran Masoud , Taghizadeh Mohsen , Gholamrezayi Afsaneh , Aryaeian Naheed
Published: January 2023

Objectives

Cornus mas fruit has various antioxidants and anti-inflammatory properties, so this study aims at assessing its effect on menopausal symptoms and sex hormones in postmenopausal women.

Methods

In the current randomized, double-blind clinical trial, 84 individuals (42 per group) were participated. C mas hydroalcoholic extract was prepared, and participants received 300 mg C mas extract or placebo three times a day (900 g in total) for 8 weeks. The demographic, dietary intake, and physical activity information were gathered. Anthropometric indices were measured by standard methods. Furthermore, menopause symptoms were assessed by Greene Climacteric Scale. Also, sex hormones were measured by enzyme-linked immunosorbent assay.

Results

Based on the results, there was a significant difference in total Greene score reduction between the intervention and placebo groups (−3.19 ± 0.54, −0.76 ± 0.32, and P < 0.001). In addition, vasomotor symptoms had a remarkable decrease in the C mas extract group (P < 0.001). Also, the intervention group demonstrated a decreasing trend in the number and duration of hot flushes. Moreover, follicle-stimulating hormone remarkably decreased and estradiol increased in the intervention group (P = 0.016 and P = 0.018).

Conclusions

It has been found that the extract of C mas fruit has a favorable effect on vasomotor symptoms, sex hormones, and related complications in women experiencing menopausal symptoms.
Superficial dyspareunia treatment with hyperstacking of erbium:yttrium-aluminum-garnet SMOOTH laser: a short-term, pilot study in breast cancer survivors
Authors: Fidecicchi Tiziana , Gaspar Adrian , Gambacciani Marco
Published: January 2023

Objective

This prospective pilot study aimed to evaluate the effects of a modified vaginal erbium laser (VEL) protocol, using the hyperstack mode on the vaginal vestibulum and introitus to treat superficial dyspareunia in postmenopausal breast cancer survivors suffering from the genitourinary syndrome of menopause.

Methods

In this pilot, prospective, randomized study, two groups of postmenopausal women suffering from superficial dyspareunia were included: 34 women (VEL group) were treated with erbium laser crystal yttrium-aluminum-garnet (XS Fotona SMOOTH; Fotona, Ljubljana, Slovenia) with a wavelength of 2,940 nm; for the other 34 (hyperstack group), a modified second step of the VEL protocol for the treatment of vestibulum and introitus was used, with hyperstacked (repeating a number of) subablative, long pulses with very low fluences. For each group, three laser applications at 30-day intervals were performed. Symptoms were assessed before, after each application, and after 1 and 3 months from the last laser application, using the visual analog scale score for superficial dyspareunia.

Results

Superficial dyspareunia improved in both groups over time (P < 0.001), regardless of age and years since menopause status. The reduction in visual analog scale score after the third laser application was 58% in VEL versus 73.5% in hyperstack. The hyperstack group, since the first laser application, showed a greater (P < 0.001) and persistent improvement of superficial dyspareunia.

Conclusions

The hyperstack treatment of the introitus and vestibulum in breast cancer survivors leads to a more significant improvement in superficial dyspareunia than the VEL alone.
One in Three Chance of Finding A Plastic Surgeon on Major Hospital Websites
Authors: Singh Nikhi P. , Boyd Carter J. , Aluri Akshay , Kovac Stefan , Mainali Bipul , Girardi Abdias , Duke Riley , King Timothy W. , de la Torre Jorge
Published: January 2023

Background:

There is an increasing trend of nonplastic surgeons performing breast surgery. Within, we evaluate the representation of plastic surgeons listed for breast reconstruction on major hospital system websites within the United States.

Methods:

The website search engines for the top 20 US medical centers according to the US News and World Report’s Hospital Rankings from 2020 to 2021 were queried for search terms pertaining to breast reconstruction. Information collected for search results included gender, if they were a physician, medical specialty, medical school and residency attended, and each individual’s position within the search results.

Results:

Across 80 distinct search attempts, 27 searches (34%) produced no results. The search term “breast reconstruction” yielded the most plastic surgeon search results, with plastic surgeons composing 39% of all search results. The search term “mastectomy” generated the least number of plastic surgeon results, with a 16% representation of plastic surgeons. Nearly two-thirds of physicians identified were nonplastic surgeons (67%). Other surgeons represented 47% of search results and obstetricians/gynecologists, 2%. Nonsurgeons represented 18% of queries. On average, plastic surgeons appeared higher on search lists than nonplastic surgeons, 13th to 39th, respectively (P < 0.001).

Conclusions:

Plastic surgeons composed only a third of physicians identified, and a third of searches produced no results. Patients interested in breast reconstruction may encounter difficulty finding an appropriate plastic surgeon. Inadequate search engines on hospital websites introduce inefficiencies for the entire health care systems and may negatively impact hospital and physician bottom line.
Impact of fentanyl analgesia on the accuracy of HVPG measurements in patients with cirrhosis: a prospective, multicenter study
Authors: Zhang Haijun , Yang Lili , Yu Ziniu , Li Dan , Li Lei , Li Shuangxi , Yan Jun , Li Xun
Published: January 2023

Background:

HVPG measurement is the gold standard for assessing portal hypertension. Many patients decline HVPG measurements due to associated pain. According to previous studies, propofol sedation during HVPG measurements potentially alters HVPG readings. However, opioid analgesics’ effects on HVPG await full elucidation. This study aimed to evaluate fentanyl analgesia’s effects on HVPG measurement accuracy in patients with cirrhosis.

Methods:

This prospective, multicenter study included patients with cirrhosis undergoing HVPG measurements, which were performed preanalgesia and under analgesia with fentanyl injection (1.0 or 1.5 μg/kg).

Results:

Of the 48 enrolled patients with cirrhosis, 23 were administered 1.0 μg/kg fentanyl analgesia during HVPG measurement. The HVPG was 13.4±4.9 mm Hg in preanalgesia and 13.5±5.2 mm Hg under analgesia. HVPG measurement accuracy was not altered after fentanyl analgesia (p = 0.801). The following measures also did not change: heart rate (p = 0.132), mean arterial pressure (p = 0.348), and blood oxygen saturation (p = 0.748); however, respiratory rate (p = 0.001) changes occurred. The Verbal Numerical Rating Score for comfort under analgesia was higher than that in preanalgesia (p = 0.001). Twenty-five patients were administered 1.5 μg/kg fentanyl analgesia during HVPG measurement. The HVPG was 19.5±5.7 mm Hg in preanalgesia and 19.6±5.6 mm Hg under analgesia. HVPG measurement accuracy did not alter after fentanyl analgesia (p = 0.469). Similarly, the following measures did not change: mean arterial pressure (p = 0.871) and oxygen saturation (p = 0.327); nevertheless, respiratory rate (p = 0.015) and heart rate (p = 0.019) changes occurred. The Verbal Numerical Rating Score for comfort under analgesia was higher than that in preanalgesia (p < 0.001).

Conclusion:

Fentanyl analgesia did not alter HVPG measurement accuracy, and fentanyl improved comfort in patients with cirrhosis during HVPG measurements.
Exosomal proteomics identifies RAB13 as a potential regulator of metastasis for HCC
Authors: Huang Xiu-Yan , Zhang Jun-Tao , Li Feng , Li Ting-Ting , Shi Xiang-Jun , Huang Jin , Huang Xin-Yu , Zhou Jian , Tang Zhao-You , Huang Zi-Li
Published: January 2023

Background:

Exosomal proteins from cancer cells are becoming new biomarkers for cancer monitoring and efficacy evaluation. However, their biological function and molecular mechanism underlying tumor metastasis are largely unknown.

Methods:

Bioinformatic methods such as bulk gene expression analysis, single-cell RNA sequencing data analysis, and gene set enrichment analysis were employed to identify metastasis-associated proteins. The in vitro and in vivo experiments were used to investigate the function of RAB13 in HCC metastasis.

Results:

We identified RAB13 as one of the critical regulators of metastasis in HCC-derived exosomes for the first time. In vitro, the invasiveness of HCC cell lines could be attenuated by RAB13 silence. In vivo, tumor size and proportion of high-grade lung metastatic nodule could be reduced in the mice with orthotopic transplantation of tumors and intravenously injected with exosomes derived from MHCC97H cell with RAB13 silence (si-RAB13-Exo), as compared with those without RAB13 silence (si-NC-Exo). Moreover, in si-RAB13-Exo group, circulating tumor cell counts were decreased at the third, fourth, and fifth weeks after orthotopic transplantation of tumors, and MMP2 (matrix metalloproteinase 2)/TIMP2 (tissue inhibitor of metalloproteinases 2) ratio was also significantly decreased. In addition, RAB13 expression was also associated with VEGF levels, microvessel density, and tube formation of vascular endothelial cells by both in vitro and in vivo models, indicating that RAB13 was associated with angiogenesis in HCC.

Conclusions:

We have demonstrated exosomal RAB13 as a potential regulator of metastasis for HCC by in silico, in vitro, and in vivo methods, which greatly improve our understanding of the functional impact of exosomal proteins on HCC metastasis.
Autopsy histology data suggest cirrhosis is frequently under-reported on death certificates
Authors: Hagström Hannes , Simon Tracey G. , Söderling Jonas , Ludvigsson Jonas F.
Published: January 2023

Background:

Cirrhosis may be asymptomatic yet contribute to ill health. Here, we studied how often cirrhosis is discovered first at an autopsy. We also examined how frequent this finding was not reported on formal death certificates.

Methods:

We used register-based data from all liver biopsies in Sweden performed after death. Cross-linkage to national registers was performed to examine how often such patients had accurate coding for cirrhosis on their death certificates.

Findings:

A total of 6187 patients with a liver biopsy performed after death, showing cirrhosis. Of these, 2523 (41%) did not have a diagnosis corresponding to cirrhosis on their final death certificate.
The Experience of Palliative Care Nurses in Qatar During the Time of COVID-19: A Qualitative Study
Authors: JOHNSON Jessie , AL BULUSHI Asma , IDRIS Zeinab , ESSA Ziad Abu , HASSAN Azza
Published: January 2023

Background

The COVID-19 pandemic has been a source of significant confusion and fear for healthcare workers as they try to maintain some sense of normalcy within their daily practices. One of the many areas affected by this pandemic has been palliative care. Palliative care nurses were thrust into a world of chaos as they faced increasing numbers of patients who were in the process of dying.

Purpose

The aim of this research was to explore the caring experiences of palliative care nurses during the COVID-19 pandemic.

Methods

A qualitative interpretive description design was used to explore the experience of nurses caring for dying patients in a palliative care unit during the COVID-19 pandemic. Twenty-two nurses working in a palliative care unit participated in this study. Data were collected during 1.5- to 2-hour focus group sessions that were guided by open-ended questions.

Results

The collected data were analyzed and coded into themes, including (a) transitioning to the new normal, (b) ethical dilemmas, and (c) collaboration and support for fellow colleagues.

Conclusions

Although the COVID-19 pandemic has not yet ended, this study provides relevant implications for practice. These implications include (a) holding continuing education sessions to help nurses better understand the meaning of pandemic conditions and how best to respond and (b) supporting nurses to better cope with the additional burdens faced because of increased patient loads. Overall, the nurses in this study were shown to have demonstrated reliance and resilience in the face of COVID-19.
Development and Evaluation of Neighborhood Care Volunteer Training Programs—Preparing for Older Adult Community Care in Taiwan
Authors: KUNG Pen-Chen , CHE Hui-Lian , WONG Alice M. K. , LIAO Yen Ting , SUNG Ya Li , HUANG Huei-Ling
Published: January 2023

Background

The prevalence of chronic diseases and functional disorders is projected to escalate as the older adult population increases. Thus, the demand for and burdens of long-term care are increasing. Training middle-aged and older volunteers at the community level will enhance health promotion and disease prevention in communities.

Purpose

In this study, multilevel volunteer training programs and related implementation methods were designed for neighborhood caregivers

Methods

This study was divided into two phases. In Phase 1, an expert review was conducted using the modified Delphi method to congregate expert opinions into an interdisciplinary consensus and establish the content and methods of implementation of the multilevel training program. In Phase 2, the training programs were implemented and evaluated.

Results

In Phase 1, 17 experts in geriatric and long-term care were enrolled in the Delphi surveys. Consensus was defined as at least 80% agreement. These experts devised volunteer training programs for neighborhood caregivers at three levels: basic caregiver training, advanced caregiver training, and volunteer caregiver instructor training. The curriculum focused on fulfilling the health demands of neighborhood care; adopted disability-prevention and disability-delaying healthcare as the basic framework; and referred to the attention, relevance, confidence, and satisfaction model of motivational design. This model of motivational design drew on the attributes of volunteers and the current state of care programs, including interest, program difficulty, and feasibility of future services. In Phase 2, 50 community middle-aged and older volunteers enrolled in the training programs and, after completing the program, were asked to evaluate their satisfaction with the program content and program effectiveness. A high level of satisfaction was reported across all three levels.

Conclusions/Implications for Practice

The training programs achieved satisfactory consistency and convergence and were well received by the volunteer trainees. These programs may be referenced in the development of future training programs and the creation of a model of community healthcare services. The curriculum was designed from the learners' perspective with direct healthcare applications. A progressive multilevel set of neighborhood care volunteer training programs was offered to cultivate community volunteers.
Bacterascites confers poor patient prognosis beyond MELD prediction
Authors: King Ji Jade , Halliday Neil , Mantovani Anna , Gerussi Alessio , Wey Emmanuel Q. , Tan Jaclyn , Ryan Jennifer , Patch David , Tsochatzis Emmanuel , Westbrook Rachel H.
Published: January 2023

Spontaneous bacterial peritonitis (SBP) is a well-recognized clinical entity with a poor prognosis. In comparison, the prevalence, microbiological flora, and prognostic significance of bacterascites (BA) (the presence of organism on culture but ascitic PMN <250 cells/mm³) is largely unknown. We, therefore, assessed the prognosis and predictors of outcome in patients with BA in comparison with those with SBP. Ascitic fluid cultures from consecutive patients with cirrhosis from 2008 to 2018 were reviewed retrospectively, and patients with SBP and BA were identified. Baseline demographic, laboratory, and microbiological data were collated and analyzed as prognostic indicators, and clinical outcomes were recorded. Patients were censored at the time of LT, death, or last follow-up. For this study 176 and 213 cases of SBP and BA, respectively, were identified and included. Patients with SBP had significantly higher Model for End-Stage Liver Disease (MELD) (p=<0.01), peripheral blood WCC (p < 0.01), and higher rates of Enterobacteriaceae (p < 0.01) and multi-drug resistant pathogens (p < 0.01). Survival at 1 and 3 months was lower in patients with SBP (p < 0.01) when compared with BA but at 6 months and beyond, no significant difference remained. After the exclusion of deaths within 30 days of presentation, survival between SBP and BA was equivocal at all time points. Mortality was substantially higher across all MELD groupings for both SBP and BA when compared with the predicted mortality calculated by the MELD score alone. BA has a negative impact on patient survival above that predicted by the MELD score. It has similar impact to SBP on patient survival beyond 1 month suggesting it should be seen as a poor prognostic marker and prompt consideration of LT where appropriate. Further studies evaluating the role of secondary prophylaxis in this group are required.
Complications and Utility of Gastrointestinal Endoscopy Post Hematopoietic Stem Cell Transplantation: An 11 Year Experience
Authors: Chan Joseph , Ganosi Vasiliki , Basude Dharamveer , Mirci-Danicar Oana C. , Wiskin Anthony E.
Published: January 2023

Objectives:

Diagnostic gastrointestinal (GI) endoscopy is used to differentiate GI graft versus host disease (GI-GvHD), which requires escalation of immunosuppressive treatment (IST), from other conditions such as viral infection, which may require reduction of IST. The aim of this study was to establish the clinical utility of GI endoscopy post hematopoietic stem cell transplant (HSCT) and the complication rate of these procedures.

Methods:

This was a single-center observational retrospective cohort study. Hospital pediatric endoscopy and HSCT databases identified patients between January 2010 and December 2020. GI-GvHD was diagnosed if there were positive histological findings and clinical context. Data collected included demographics, timing of endoscopy post-HSCT, clinical utility, and complications of endoscopy. The endoscopy was deemed to be “clinically useful” if it resulted in a change of clinical management or helped to narrow down the differential diagnosis for the clinical team.

Results:

Three hundred thirty-nine HSCT occurred in 320 children during the study period. Sixty-six of 339 (19%) HSCT needed an “endoscopy episode.” One hundred nineteen endoscopies were performed (53 concurrent upper and lower GI endoscopies, 11 upper GI endoscopies, and 2 lower GI endoscopies). Four of 119 (3%) endoscopies had complications: septic shock (1), duodenal hematoma (1), GI bleeding (1), and colonic perforation (1). Four patients had incomplete records to assess utility of endoscopy. Fifty-seven of 62 (92%) endoscopy episodes were “clinically useful,” and 41 of 62 (66%) had a change in IST.

Conclusions:

The clinical utility of endoscopy is high and in the majority of cases is associated with a change in patient management. Children post-HSCT are at high risk of complications from endoscopy; this should be made clear in the process of obtaining consent for procedures.
Psychosocial factors as main predictors of quality of life 5 years after stroke: a cross-sectional study from a third-level Italian center
Authors: Marcassoli Alessia , Guastafierro Erika , Toppo Claudia , Leonardi Matilde , Bersano Anna , Boncoraglio Giorgio , Canavero Isabella , Raggi Alberto
Published: January 2023

Stroke causes a significant reduction in health-related quality of life (HRQoL), and studies addressing its predictors often rely on models with few variables. This study aimed to assess the degree to which health status, health habits, and features of the environment predict HRQoL in stroke survivors with stable clinical condition. WHO Quality of Life questionnaire for old-Age subjects (WHOQOL-AGE) was used to assess HRQoL. We ran a multivariable linear regression to predict WHOQOL-AGE variation, entering measures of health state, bad habits, healthy behaviors, physical environment features, and social support. Patients were stroke survivors with a stable clinical condition, distance from acute event of more than 6 months, and National Institutes of Health Stroke Scale (NIHSS) of 10 or less. A total of 122 participants (47 females, 97 with ischemic stroke) were enrolled, the mean age was 64.1, mean NIHSS 2.9, and mean distance from the acute event was 5.1 years. State anxiety (β = −0.202), trait anxiety (β = −0.232), depression (β = −0.255), social support (β = 0.247), and functional independence (β = −0.210) predicted WHOQOL-AGE variation (Adj.R2= 0.549). Our results show that psychological symptoms, reduced social network, and functional dependence together have a negative impact on HRQoL. These elements, which are partly stroke-specific, should be taken into account in the recovery process to enhance patients’ health outcomes.
A Year Later: Beyond Gratitude
Authors: Zimmermann Deborah T.
Published: January 2023

“Not expressing gratitude is like wrapping a present and never giving it.” –William Ward

Regular expressions of gratitude and meaningful recognition are beginning to make a difference for nurse managers. Beyond Gratitude: A Tribute to Nurse Managers illustrates how the power of a partnership of 2 foundations can make a difference.
An Innovative Academic/Practice Partnership to Support Nursing Workforce Needs and Student Clinical Education
Authors: Hahn Judith , Resha Cheryl-Ann , Beauvais Audrey , Beckman Beth , Forte Pamela , Rebeschi Lisa M. , Snyder Marianne
Published: January 2023

Innovation is needed to solve nursing workforce issues during times of crisis. A collaborative effort between a hospital system and several universities resulted in the Bridge to Professional Practice Program that was implemented during a period of high patient volume and nursing student downtime. The program provided support for staffing needs and clinical hours to promote readiness for practice for students. The program evaluation outcomes and recommendations for improvement are addressed.
Voluntary Separations and COVID-19: A Snapshot of Turnover Intention in the Federal Workforce in the First Year of the Pandemic
Authors: Orr Jason M. , Leider Jonathon P.
Published: January 2023

Voluntary separations can exact heavy tolls on organizations that affect their efficiency or effectiveness. This historical retrospective investigates how the COVID-19 pandemic may have influenced federal employees' intention to leave for reasons other than retirement. We examined the 2020 Federal Employee Viewpoint Survey (FEVS) with a particular focus on agencies likely heavily impacted by the pandemic, including the Departments of Agriculture (USDA), Health and Human Services (HHS), Homeland Security (DHS) and the US Environmental Protection Agency (EPA). We used inferential statistics and a logistic model to identify correlations for intent to leave, considering changes related to the pandemic. Intentions to leave notably increased after the pandemic for most respondents, and overall intentions to leave were lower for USDA, HHS, and EPA staff than for all federal employees. Reasons included perceived unavailability of protections from COVID-19 exposure, disruptions to work by the pandemic, and increased work demands due to the pandemic.
Gene Expression Profiles in Cancers and Their Therapeutic Implications
Authors: Creighton Chad J.
Published: January 2023

The vast amount of gene expression profiling data of bulk tumors and cell lines available in the public domain represents a tremendous resource. For any major cancer type, expression data can identify molecular subtypes, predict patient outcome, identify markers of therapeutic response, determine the functional consequences of somatic mutation, and elucidate the biology of metastatic and advanced cancers. This review provides a broad overview of gene expression profiling in cancer (which may include transcriptome and proteome levels) and the types of findings made using these data. This review also provides specific examples of accessing public cancer gene expression data sets and generating unique views of the data and the resulting genes of interest. These examples involve pan-cancer molecular subtyping, metabolism-associated expression correlates of patient survival involving multiple cancer types, and gene expression correlates of chemotherapy response in breast tumors.
A Brief Overview of Cancer Vaccines
Authors: Muller Alexander J. , Thomas Sunil , Prendergast George C.
Published: January 2023

Vaccine strategies for cancer differ from infectious disease in focusing mainly on clearing rather than preventing disease. Here we survey general vaccine strategies and combination therapy concepts being investigated for cancer treatment, with a focus on tumor antigens rather than cancer-inducing viruses or microorganisms. Many tumor antigens are “altered-self” and tend to arouse weaker immune responses than “foreign” antigens expressed by infectious agents. Further, unlike an infectious disease patient, a cancer patient's immune system is damaged, suppressed, or senescent and mainly tolerant of their disease. Thus, vaccine efficacy in a cancer patient will rely upon adjuvant or combination treatments that correct the inflammatory tumor microenvironment and degrade tumoral immunosuppression that dominates patient immunity. This brief overview is aimed at new researchers in cancer immunology seeking an overview of vaccine concepts to eradicate malignancy by provoking a selective immune attack.
Impact of Precision Medicine in Oncology
Authors: Buchbinder Elizabeth I. , Hodi F. Stephen
Published: January 2023

Cancer treatment has dramatically changed over the last decade with the development of immunotherapy. Therapies including immune cytokines, immune checkpoint inhibition, intratumoral therapies, and cellular therapies are already widely used in the oncology clinic. Active development continues in these areas and in the development of vaccines, bispecific therapies, and more refined cellular therapies. In this review, we will examine the role that immune therapy has in cancer treatment and explore areas of future development.