bluuebunny/crossref_metadata_2025 huggingface dataset:
Multi-endpoint analysis of cadmium chloride-induced genotoxicity shows role for reactive oxygen species and p53 activation in DNA damage induction, cell cycle irregularities, and cell size aberrations
Authors: Stannard Leanne M , Doherty Ann , Chapman Katherine E , Doak Shareen H , Jenkins Gareth J
Published: August 2023

Cadmium chloride (CdCl2) is a known genotoxic carcinogen, with a mechanism of action thought to partly involve the generation of reactive oxygen species (ROS). We applied here a multi-endpoint approach in vitro to explore the impact of CdCl2 on both the genome and on wider cell biology pathways relevant to cancer. Multi-endpoint approaches are believed to offer greater promise in terms of understanding the holistic effects of carcinogens in vitro. This richer understanding may help better classification of carcinogens as well as allowing detailed mechanisms of action to be identified. We found that CdCl2 caused DNA damage [micronuclei (MN)] in both TK6 and NH32 cells in a dose-dependent manner after 4 h exposure (plus 23 h recovery), with lowest observable effect levels (LOELs) for MN induction of 1 μM (TK6) and 1.6 μM (NH32). This DNA damage induction in TK6 cells was ROS dependent as pretreatment with the antioxidant N-Acetyl Cysteine (1 mM), abrogated this effect. However, 2ʹ,7ʹ-dichlorofluorescin diacetate was not capable of detecting the ROS induced by CdCl2. The use of NH32 cells allowed an investigation of the role of p53 as they are a p53 null cell line derived from TK6. NH32 showed a 10-fold increase in MN in untreated cells and a similar dose-dependent effect after CdCl2 treatment. In TK6 cells, CdCl2 also caused activation of p53 (accumulation of total and phosphorylated p53), imposition of cell cycle checkpoints (G2/M) and intriguingly the production of smaller and more eccentric (elongated) cells. Overall, this multi-endpoint study suggests a carcinogenic mechanism of CdCl2 involving ROS generation, oxidative DNA damage and p53 activation, leading to cell cycle abnormalities and impacts of cell size and shape. This study shows how the integration of multiple cell biology endpoints studied in parallel in vitro can help mechanistic understanding of how carcinogens disrupt normal cell biology.
A disintegrin and metalloproteinase 22 activates integrin β1 through its disintegrin domain to promote the progression of pituitary adenoma
Authors: Xing Biao , Lei Zhuowei , Wang Zihan , Wang Quanji , Jiang Qian , Zhang Zhuo , Liu Xiaojin , Qi Yiwei , Li Sihan , Guo Xiang , Liu Yanchao , Li Xingbo , Shu Kai , Zhang Huaqiu , Bartsch Jörg Walter , Nimsky Christopher , Huang Yimin , Lei Ting
Published: August 2023

Background

Approximately 35% of pituitary adenoma (PA) display an aggressive profile, resulting in low surgical total resection rates, high recurrence rates, and worse prognosis. However, the molecular mechanism of PA invasion remains poorly understood. Although “a disintegrin and metalloproteinases” (ADAMs) are associated with the progression of many tumors, there are no reports on ADAM22 in PA.

Methods

PA transcriptomics databases and clinical specimens were used to analyze the expression of ADAM22. PA cell lines overexpressing wild-type ADAM22, the point mutation ADAM22, the mutated ADAM22 without disintegrin domain, and knocking down ADAM22 were generated. Cell proliferation/invasion assays, flow cytometry, immunohistochemistry, immunofluorescence, co-immunoprecipitation, mass spectrometry, Reverse transcription-quantitative real-time PCR, phos-tag SDS-PAGE, and Western blot were performed for function and mechanism research. Nude mice xenograft models and rat prolactinoma orthotopic models were used to validate in vitro findings.

Results

ADAM22 was significantly overexpressed in PA and could promote the proliferation, migration, and invasion of PA cells. ADAM22 interacted with integrin β1 (ITGB1) and activated FAK/PI3K and FAK/ERK signaling pathways through its disintegrin domain to promote PA progression. ADAM22 was phosphorylated by PKA and recruited 14-3-3, thereby delaying its degradation. ITGB1-targeted inhibitor (anti-itgb1) exerted antitumor effects and synergistic effects in combination with somatostatin analogs or dopamine agonists in treating PA.

Conclusions

ADAM22 was upregulated in PA and was able to promote PA proliferation, migration, and invasion by activating ITGB1 signaling. PKA may regulate the degradation of ADAM22 through post-transcriptional modification levels. ITGB1 may be a potential therapeutic target for PA.
Similar post-fledging behavior observed in wild and reintroduced juvenile Bonelli’s Eagle in ﻿two Mediterranean islands
Authors: Egea-Casas Olga , López-López Pascual , Álvarez Ernesto , Cortone Giuseppe , Galán Manuel , Iglesias-Lebrija Juan José , Lo Valvo Mario , Martínez Juan , Merlino Stefania , Viada Carlota , Di Vittorio Massimiliano
Published: August 2023

Reintroduction projects are gaining popularity; however, their relatively elevated cost and chance of failure make them debatable, hence assessing their effectiveness is essential. Within the early stages of raptors, the post-fledging dependency period (PFDP) is the one in which individuals must face dangers without having completely developed their skills. Thereby, comparing PFDP patterns concerning reintroduced and wild individuals is of major interest as it would help to plan and improve future conservation actions. We analyzed the behavior of 38 juvenile Bonelli’s Eagles (Aquila fasciata) (15 reintroduced and 23 wild) tracked through GPS telemetry, tagged as nestlings in ﻿two insular environments. The study period encompassed 9-yr movement data from reintroduced chicks in Mallorca (Spain) and wild chicks from Sicily (Italy). Movement parameters (i.e., age of first flight, age of dispersal, length of the PFDP, revisits to the natal or release area, and residence time in them) were analyzed together with their behavior for reintroduced and wild individuals. Similar movement patterns were obtained for both origins, although wild individuals revisited the natal site more often and dispersed earlier. Behavior was also similar, though it varied throughout the PFDP, observing a more abrupt progress in wild individuals and an earlier development of travelling and hunting behaviors. Observed differences are probably related to food availability, which can improve body condition and thus delay onset of dispersal, together with parental presence, which can prompt an earlier ending of the PFDP by encouraging juvenile independence. In conclusion, our study provides valuable insights into the behavior of reintroduced Bonelli’s Eagles during their PFDP and how it compares to their wild counterparts. Our results suggest that reintroduced individuals can successfully adapt to their environment and behave similarly to wild individuals. These findings can aid in the planning and improvement of future reintroduction projects and conservation actions for this endangered species.
Urine drug testing in the context of opioid analgesic prescribing for chronic pain: a content analysis of U.S. state laws in 2022
Authors: Andraka-Christou Barbara , McAvoy Elizabeth , Gordon Adam J , Ohama Maggie , Brach Marilyn , Taylor Erin A , Vaiana Mary , Saloner Brendan , Stein Bradley D
Published: August 2023

Background

In response to the opioid crisis, U.S. states have passed laws requiring urine drug testing (UDT) when opioid analgesics are prescribed for chronic pain. We sought to identify state law UDT requirements.

Methods

We searched NexisUni legal database using terms related to UDT, chronic pain, and opioids. We included laws effective during spring 2022 that required UDT when opioids were prescribed for chronic pain. We performed deductive content analysis, coding laws for mandated UDT frequency, type of clinician and type of payer to whom the law applied, and circumstances under which UDT was mandated.

Results

We found 32 laws across 13 states that met our inclusion criteria. UDT requirements varied substantially by state, including with regard to the type of clinician to whom the law applied, the mandated frequency of UDT (eg, at initiation/assessment, at least annually, more than once per year), and the circumstances in which UDT was mandated (eg, patient had substance use disorder; dosage/day threshold).

Discussion

Relatively few states have UDT mandates associated with prescribing opioids as chronic pain treatment. When developing policy indicators for empirical studies, researchers evaluating how UDT policy affects health outcomes must consider the complexity and lack of uniformity of UDT requirements. In addition, even if states mandate UDT, it is unclear whether clinicians understand the best way to use the test results.
A single-nucleotide substitution of CjTKPR1 determines pollen production in the gymnosperm plant Cryptomeria japonica
Authors: Kakui Hiroyuki , Ujino-Ihara Tokuko , Hasegawa Yoichi , Tsurisaki Eriko , Futamura Norihiro , Iwai Junji , Higuchi Yuumi , Fujino Takeshi , Suzuki Yutaka , Kasahara Masahiro , Yamaguchi Katsushi , Shigenobu Shuji , Otani Masahiro , Nakano Masaru , Nameta Masaaki , Shibata Shinsuke , Ueno Saneyoshi , Moriguchi Yoshinari
Published: August 2023

Pollinosis, also known as pollen allergy or hay fever, is a global problem caused by pollen produced by various plant species. The wind-pollinated Japanese cedar (Cryptomeria japonica) is the largest contributor to severe pollinosis in Japan, where increasing proportions of people have been affected in recent decades. The MALE STERILITY 4 (MS4) locus of Japanese cedar controls pollen production, and its homozygous mutants (ms4/ms4) show abnormal pollen development after the tetrad stage and produce no mature pollen. In this study, we narrowed down the MS4 locus by fine mapping in Japanese cedar and found TETRAKETIDE α-PYRONE REDUCTASE 1 (TKPR1) gene in this region. Transformation experiments using Arabidopsis thaliana showed that single-nucleotide substitution (“T” to “C” at 244-nt position) of CjTKPR1 determines pollen production. Broad conservation of TKPR1 beyond plant division could lead to the creation of pollen-free plants not only for Japanese cedar but also for broader plant species.
Diffusion-weighted magnetic resonance imaging for the diagnosis of giant cell arteritis: a comparison with T1-weighted black-blood imaging
Authors: Seitz Luca , Bucher Susana , Bütikofer Lukas , Maurer Britta , Bonel Harald M , Wagner Franca , Lötscher Fabian , Seitz Pascal
Published: August 2023

Objectives

To investigate the diagnostic performance of diffusion-weighted imaging (DWI) of the superficial cranial arteries in the diagnosis of GCA.

Methods

Retrospectively, 156 patients with clinically suspected GCA were included. A new 4-point ordinal DWI rating scale was developed. A post-contrast, fat-suppressed, T1-weighted ‘black-blood’ sequence (T1-BB) was rated for comparison. Ten arterial segments were assessed: common superficial temporal arteries, temporal and parietal branches, occipital and posterior auricular arteries bilaterally. The expert clinical diagnosis after ≥6 months of follow-up was the diagnostic reference standard. Diagnostic accuracy was evaluated for different rating methods.

Results

The study cohort consisted of 87 patients with and 69 without GCA. For DWI, the area under the curve was 0.90. For a cut-off of ≥2 consecutive pathological slices, DWI showed a sensitivity of 75.9%, a specificity of 94.2% and a positive likelihood ratio of 13.09. With a cut-off of ≥3 consecutive pathological slices, sensitivity was 70.1%, specificity was 98.6% and the positive likelihood ratio was 48.38. For the T1-BB, values were 88.5%, 88.4% and 7.63, respectively. The inter-rater analysis for DWI with a cut-off of ≥2 pathological slices showed a kappa of 1.00 on the patient level and 0.85 on the arterial segment level. For the T1-BB the kappa was 0.78 and 0.79, respectively.

Conclusion

DWI of the superficial cranial arteries demonstrates a good diagnostic accuracy and reliability for the diagnosis of GCA. DWI is widely available and can be used immediately in clinical practice for patients with suspected GCA.
The effect of contact radiation shielding on breast dose during CT abdomen–pelvis: a phantom study
Authors: Long Maria , Albeshan Salman , Alashban Yazeed , England Andrew , Moore Niamh , Young Rena , Bezzina Paul , McEntee Mark F
Published: August 2023

This study aims to investigate if contact shielding reduces breast radiation dose during computed tomography (CT) abdomen–pelvis examinations using automatic tube current modulation to protect one of the four most radiosensitive organs during CT examinations. Dose measurements were taken with and without contact shielding across the anterior and lateral aspects of the breasts and with and without organ dose modulation (ODM) to quantify achievable dose reductions. Although there are no statistically significant findings, when comparing with and without shielding, the mean breast surface dose was reduced by 0.01 μSv without ODM (1.92–1.91 μSv, p = 0.49) and increased by 0.03 μSv with ODM (1.53–1.56 μSv, p = 0.44). Comparing with and without ODM, the mean breast surface dose was reduced by 0.35 μSv with shielding (1.91–1.56 μSv, p = 0.24) and by 0.39 μSv without shielding (1.92–1.53 μSv, p = 0.17). The addition of contact shielding does not provide significant breast surface radiation dose reduction during CT abdomen–pelvis.
In control or along for the ride? Lessons for anesthesiologists from air traffic control
Authors: Ruskin Keith J. , Dutton Richard P. , Ruskin Anna Clebone
Published: August 2023

Purpose of review

Anesthesia professionals work in an unpredictable, rapidly changing environment in which they are quickly diagnose and manage uncommon and life-threatening critical events. The perioperative environment has traditionally been viewed as a deterministic system in which outcomes can be predicted, but recent studies suggest that the operating room behaves more like a complex adaptive system, in which events can interact and connect with each other in unpredictable and unplanned ways.

Recent findings

The increasing complexity of the healthcare environment suggests that the complete elimination of human error is not possible. Complex clinical situations predispose to errors that are the result of high workload, decision making under stress, and poor team coordination. The theory behind complex adaptive systems differs from medicine's traditional approach to safety and highlights the importance of an institutional safety culture that encourages flexibility, adaptability, reporting and learning from errors. Instead of focusing on standardization and strict adherence to procedures, clinicians can improve safety by recognizing that unpredictable changes routinely occur in the work environment and learning how resilience can prevent adverse events.

A better understanding of automation, complexity, and resilience in a changing environment are essential steps toward the safe practice of anesthesia.
Obesity Paradox for Postoperative Mortality in Young Chinese Patients Undergoing Craniotomy for Brain Tumor Resection
Authors: He Jialing , Jia Lu , Zhang Yu , Tian Yixin , Hao Pengfei , Li Tiangui , Xiao Yangchun , Peng Liyuan , Feng Yuning , Cheng Xin , Deng Haidong , Wang Peng , Chong Weelic , Hai Yang , Chen Lvlin , You Chao , Fang Fang
Published: August 2023

Background:

There is little evidence regarding the association of body mass index (BMI) with postoperative mortality after craniotomy, especially in the Asian population. Our study aimed to explore the association between BMI and postoperative 30-day mortality in Chinese patients undergoing craniotomy for brain tumor resection.

Methods:

This large retrospective cohort study, Supplemental Digital Content 9, http://links.lww.com/JNA/A634 collected data from 7519 patients who underwent craniotomy for brain tumor resection. On the basis of the World Health Organization obesity criteria for Asians, included patients were categorized as underweight (<18.5 kg/m2), normal weight (18.5 to 22.9 kg/m2), overweight (23to 24.9 kg/m2), obese I (25 to 29.9 kg/m2), and obese II (≥30 kg/m2). We used a multivariable logistic regression model to explore the association between different BMI categories and 30-day postoperative mortality. In addition, we also conducted stratified analyses based on age and sex.

Results:

Overweight (adjusted odds ratio 0.63, 95% CI 0.40-0.99) and obese I (adjusted odds ratio 0.44, 95% CI 0.28-0.72) were associated with decreased 30-day postoperative mortality compared with normal-weight counterparts. Such associations were prominent among younger (age younger than 65 y) patients but not older patients, and there was an interaction between age and overweight versus normal weight on mortality (P for interaction=0.04).

Conclusions:

We found that among Chinese patients undergoing craniotomy for brain tumors, there was a J-shaped association between BMI and postoperative 30-day mortality, with lowest mortality at 27 kg/m². Moreover, in young patients, overweight and obese I were both associated with decreased risk of 30-day mortality.
Fragile X Syndrome and Fetal Alcohol Syndrome: Occurrence of Dual Diagnosis in a Set of Triplets
Authors: Aishworiya Ramkumar , Biag Hazel Maridith Barlahan , Salcedo-Arellano Maria Jimena , Musa Zayan , Schneider Andrea , Clark Courtney , Santos Ellery , Tassone Flora , Hagerman Randi
Published: August 2023

Background:

Fragile X syndrome (FXS) and fetal alcohol syndrome disorders are both common causes of intellectual disability in children. When both conditions are present in the same individual, the resultant phenotype may make identification of clinical issues and management challenging.

Case presentation:

In this case report, we present a case of triplets who had significant in utero alcohol exposure; 2 of whom also have FXS and the other not having the fragile X mutation. The siblings with FXS have subtle differences in the physical phenotype compared with the other one, who has prominent features of partial fetal alcohol syndrome instead. However, all 3 siblings have intellectual impairment (although this is more severe in the 2 with FXS), meet diagnostic criteria for autism spectrum disorder, and present with severe behavioral challenges. The clinical presentation of the 2 siblings with FXS is much more severe as compared to a child with FXS alone, and this is likely due to the additive effect of in utero alcohol exposure and environmental factors. We discuss the combination of these 2 pathologies and how this can affect the overall clinical presentation.

Conclusion:

In the management of children with FXS, evaluation for other risk factors that can have neurobehavioral sequelae is important, and these can affect clinical presentation and prognosis.
“She Is Stand-Offish Like That”: Black Adults' Recognition of Child Behaviors Associated with Autism Spectrum Disorder
Authors: Ashby Dejeunee , Yin Larry , Jones Felica , Wright Aziza-Lucas , Williams Helena , Williams Charlene , Deavenport-Saman Alexis , Vanderbilt Douglas , Solomon Olga
Published: August 2023

Objective:

The purpose of this study is to identify the sociocultural factors in the Black community that contribute to a delay in identification of Black children with autism spectrum disorder (ASD).

Methods:

Four focus groups with parents of typically developing children were conducted at 2 Black Churches using a community-partnered participatory research approach and the socioecological model. Participants completed sociodemographic surveys, viewed CDC Autism Training Videos of Black children with ASD, and reported on their behavioral observations. Focus groups were audio recorded and transcribed. Thematic data analysis was conducted using NVivo software.

Results:

At the individual level, participants interpreted ASD-associated behaviors as a problem of timing of developmental milestones in the course of normative development rather than a sign of a disorder and positive and negative characteristics. At the interpersonal level, the role of grandparents and extended family was important for monitoring child development. At the organizational level, racial concordance with health care providers was seen as critical because of historical mistrust. At the community level, fear of racism and child protective services and inequitable care emerged. At the policy level, there were concerns about access to affordable, high-quality care.

Conclusion:

This study provides insight into the sociocultural factors in the faith-based Black community that may contribute to a delay in identification of Black children with ASD. Health care professionals need additional training to effectively serve Black children and families in the face of historical mistrust and health care inequity.
Evaluating Rates of Positive Margins After Standard Excision of Cutaneous Adnexal Malignancies
Authors: Cheraghlou Shayan , Doudican Nicole A. , Criscito Maressa C. , Stevenson Mary L. , Carucci John A.
Published: August 2023

BACKGROUND

It is recommended to excise adnexal neoplasms with standard local excision or Mohs micrographic surgery (MMS), although many occur on high-risk sites such as the head and neck (H&N) and exhibit subclinical extension. Minimal evidence exists on the efficacy of standard excisions for these tumors.

OBJECTIVE

To evaluate the rate of positive surgical margins after standard excision of adnexal tumors.

METHODS

Retrospective cohort study of cutaneous adnexal malignancies from the National Cancer Database diagnosed from 2004 to 2019.

RESULTS

The authors identified a total of 4,402 cases treated with standard excision. Tumors on the H&N were approximately twice as likely as those on the trunk and extremities (T&E) to be excised with positive margins (odds ratio 2.146, p < .001), with the highest estimated rate for eccrine adenocarcinoma (12.1%, SE: 2.3%). The subtype with the highest positive margin rate on the T&E was microcystic adnexal carcinoma (8.0%, SE: 2.9). Positive margins were associated with poorer overall survival on multivariable survival analysis (hazard ratio 1.299, p = .015).

CONCLUSION

The authors present subtype- and site-specific positive margin rates for adnexal tumors treated with standard excision, which suggest that tumors on the H&N and some T&E subtypes, should be considered for MMS.
Evaluation and treatment of vulvovaginal itching in postmenopausal women
Authors: Mitchell Caroline
Published: August 2023

Vulvovaginal itching, a commonly reported symptom in postmenopausal women, may be because of the genitourinary syndrome of menopause but has a broad differential including dermatologic, infectious, and autoimmune causes. Comprehensive evaluation is important to avoid inappropriate treatments that may delay the correct diagnosis. In many cases, no clear cause can be identified, and the goal of management is simply to control symptoms.
Cultural diversity in health care teams: A systematic integrative review and research agenda
Authors: Schmidt Manuela , Steigenberger Norbert , Berndtzon Magnus , Uman Timur
Published: August 2023

Background

Although team-based work is deemed key to improving the quality of national health care systems, adverse events related to teamwork account for up to one third of all incidents. Health care teams are typically multiprofessional and diverse in many aspects, but cultural diversity is one of the most challenging.

Purposes

The objective of this review is to systematically analyze the literature to better understand the impact of cultural diversity in health care teams on team processes as well as team and patient outcomes. This study also explores the conditions that enable or hinder team functioning.

Methodology

Through a systematic integrative literature review, this study builds on the input–process–output–context framework. Multiple searches of the main databases led to identifying 43 relevant articles.

Findings

The results suggest that, when not proactively managed, cultural diversity may have a negative effect on team communication and integration, increasing team conflict and thereby negatively influencing team performance, team climate, and patient safety, both directly and indirectly. Yet, when managed properly and in the presence of engaged and culturally sensitive leadership, cultural training, and open and transparent procedures, cultural diversity in health care teams can be an asset to health care organizations. Analyzing and aggregating these findings into an integrative framework, our study identifies several themes and a research agenda for future studies on culturally diverse health care teams.

Practice Implications

Our findings suggest that culturally diverse health care teams experience a number of challenges, pointing to the need for action or structures that enable these teams to perform better, such as emphasizing learning and allowing team members time to get to know each other outside work.
Physiological Effects of Co-exposure to Ionizing Radiation and Noise within Occupational Exposure Limits
Authors: Liu Wenyi , Liu Huaqing , Gao Weimin , Xie Liangbin , Cao Yanmei
Published: August 2023

Workers are frequently exposed to the occupational hazards of ionizing radiation and noise. Co-exposure to these hazards is not well understood in terms of their physiological effects. The aim of this study was to investigate the physiological effects of co-exposure to ionizing radiation and noise within the occupational limit. This study extracted the physical examination parameters of workers who met the screening criteria from the occupational health surveillance database. The workers were divided into three groups: the co-exposure (COE) group, the ionizing radiation exposure (ION) group, and the non-exposure (NON) group. The age and sex of the three groups were matched with a sample size ratio of 1:3:3. The physical examination parameters of the three groups of workers were compared. The results showed that there was no significant difference in blood pressure and blood biochemical parameters among the three groups. The COE group had higher levels of free triiodothyronine than the ION group, but there was no difference with the NON group. Moreover, the COE group had lower levels of free tetraiodothyronine than the ION group and the NON group. There was no significant difference in thyroid stimulating hormone, total triiodothyronine, and total tetraiodothyronine among the three groups. Additionally, the number of white blood cells of the COE group was lower than that of ION group and NON group. This study suggests that co-exposure to low-dose ionizing radiation and noise can cause alterations in thyroid hormone and peripheral white blood cells. These alterations are different from those observed after single exposure to low-dose ionizing radiation and require further research.
Effects of a Theory-Based Educational Program on Health Behaviors and Cardiovascular Health Outcomes Among Overweight Postmenopausal Women
Authors: Chair Sek-Ying , Lo Sally Wai Sze , Cheng Ho Yu , Choi Kai Chow , Liu Ting , Wang Qun , Sit Janet Wing Hung
Published: August 2023

Background

With the natural cessation of estrogen, after menopause, women, especially those who are overweight, are at a high risk for cardiovascular disease. Diet control and adequate physical activity (PA) are recommended as the essence of promoting cardiovascular health for women after menopause.

Objective

The aim of this study was to examine the effects of a theory-based educational program on health behaviors and cardiovascular health outcomes among overweight postmenopausal Chinese women compared with conventional didactic education.

Methods

In this randomized controlled trial, 288 participants were randomly allocated to intervention (n = 144) or control (n = 144) groups. The control group received conventional didactic education. The intervention group received a 3-month theory-based educational program. Primary outcomes were PA and dietary behavior. Secondary outcomes included cardiovascular health knowledge, self-efficacy in PA and diet, and cardiovascular health outcomes. Data were collected at baseline (T0), 3 months (T1), 6 months (T2), and 12 months (T3).

Results

The intervention group demonstrated significantly greater improvements in PA, dietary behavior, self-efficacy in PA and diet, and several cardiovascular health outcomes (body weight, body mass index, waist circumference, blood pressure, and Framingham risk score [body mass index]) at postintervention compared with the control group (all Ps < .05). These significant effects maintained at T2, and the effects on self-efficacy in PA and diet also were maintained at T3.

Conclusions

A theory-based educational program may be an effective strategy for improving PA, dietary behavior, self-efficacy in PA and diet, and several cardiovascular health outcomes for overweight postmenopausal Chinese women. However, further strategies are needed to enhance the sustainability of the positive changes.
Illness Uncertainty of the Patients With Unruptured Intracranial Aneurysms Treated by Coil Embolization
Authors: Lee JiEun , Lee SukJeong , Kwon O-Ki
Published: August 2023

BACKGROUND: Patients with unruptured intracranial aneurysms (UIAs) treated by coil embolization may experience illness uncertainty despite successful treatment. This study aimed to investigate illness uncertainty in patients with UIAs treated by coil embolization and to identify the factors affecting illness uncertainty. METHODS: This cross-sectional study involved data collected from 267 patients with UIAs who received coil embolization within 2 years at a tertiary hospital in South Korea. The data were collected through structured questionnaires and the patients' medical records. The questionnaires included information on sociodemographic characteristics, the Hospital Anxiety and Depression Scale, the Multidimensional Scale of Perceived Social Support, and Mishel Uncertainty in Illness Scale data. We collected clinical characteristics through the medical records. Data analysis was performed using descriptive statistics, an independent t test, a 1-way analysis of variance, and a Pearson correlation test. We used a multiple linear regression analysis with significant variables in the univariate analysis to determine which variables had a significant impact on illness uncertainty. RESULTS: The mean Mishel Uncertainty in Illness Scale score was 52.33 (12.93). We identified age (P = .002), education level (high school graduation, P = .014; college or higher, P < .001), anxiety (P < .001), and social support (P < .001) as factors affecting illness uncertainty. CONCLUSION: Patients with UIAs who underwent coil embolization did not exhibit severe illness uncertainty. The factors affecting illness uncertainty were age, educational level, anxiety, and social support. This study provides insight into illness uncertainty in this patient population and may help develop appropriate nursing interventions.
Cochlear Implant Outcomes in the Chinese-Speaking Adult Population: A Systematic Review
Authors: Jia Tianyi , Wen Christopher Z. , Arya Priya , Riebe Natalie , Shah Arnav , Naples James G. , Kuang Jianjing , Hwa Tiffany P.
Published: August 2023

Objective

The purpose of this study is to perform a systematic review of speech perception outcomes in the Chinese-speaking adult cochlear implant (CI) population.

Databases Reviewed

PubMed, EMbase, and Scopus.

Methods

A comprehensive English literature search was performed with MeSH search terms, keywords, and phrases. Literature written in a language other than English was not included. Full-text articles were screened by two blinded reviewers and adjudicated by a third. Relevant outcomes and demographic data were extracted. Qualitative summaries were performed of the demographics and assessment tools. Speech perception outcomes were assessed with quantitative measures.

Results

Forty-four studies (n = 467) notable for marked heterogeneity in speech perception assessment utilized and reporting of relevant patient demographics were included. Mean duration of deafness among studies reporting this metric was 10.27 years (range, 0.08–49; SD, 7.70; n = 250), with 80% of subjects reporting >5 years' duration of deafness and only 19 subjects (7.6%) with <1 year of deafness preimplantation. A summary of the most commonly used assessments is provided.

Conclusion

Within the English-language literature, there is marked heterogeneity and lack of standardization regarding speech perception outcomes, tests utilized, and reported patient demographics in the Chinese-speaking adult CI population. Most Chinese-speaking CI users for whom data were available had prolonged duration of deafness before implantation. This study may serve as an initial reference for providers counseling Chinese-language CI candidates and who may be interested in adopting these tests, while highlighting the need for continued efforts to measure speech perception outcomes after CI for tonal language speakers.
Triamcinolone Injection for Cochlear Implant Magnet Adherence Issues
Authors: Tawk Karen , Goshtasbi Khodayar , Frank Madelyn , Martin Elaine C. , Abouzari Mehdi , Djalilian Hamid R.
Published: August 2023

Objectives

To evaluate the effectiveness of triamcinolone injections in treating external magnet displacement in cochlear implant (CI) patients with adhesions problems of their processor.

Patients

We present seven CI patients with magnet adhesion issues who presented to our tertiary care neurotology clinic. None of the patients had a history of head trauma, postimplant MRI, or surgery in the head and neck other than the cochlear implantation.

Intervention

Triamcinolone 40 mg/mL injected subcutaneously at the CI magnet site.

Main Outcome Measure

Reduction of scalp thickness and successful magnet retention.

Results

Our cohort consisted of seven patients (eight implant sites) of which five were overweight or obese. The temporoparietal scalp thickness measured on preoperative CT scans varied between 8.4 and 15.9 mm. Initial conservative measures such as hair shaving at the magnet site, using a headband, and increasing magnet strength failed in all patients. After receiving triamcinolone injections at the CI receiver site, six out of seven patients (seven out of eight CI sites) were able to use their processor again without the need for a headband for an average of 9.55 hours/day. The average number of injections required for each patient was 2.57 (SD = 2.18), median (range) = 1 (1–7). One patient required a flap thinning surgery but showed no improvement even after flap thinning. None of the patients showed skin irritation, breakdown, ulceration, necrosis, or magnet exposure during follow-up period.

Conclusions

The significant improvement in CI retention shows that triamcinolone injections are effective in making the subcutaneous tissue thinner and allowing magnet retention.
Socioeconomic Disparities in the Pursuit of Care at a High-Volume Institution for Surgical Resection of Vestibular Schwannomas
Authors: Du Eric Y. , Assi Sahar H. , Moshtaghi Omid , Schwartz Marc S. , Friedman Rick A. , Dixon Peter R.
Published: August 2023

Objective

Increased institutional surgical resection case volume for vestibular schwannomas (VSs) has been associated with improved patient outcomes, including reduced risk of prolonged hospital stay and readmission. Socioeconomic disparities in the pursuit of care at these high-volume institutions remain unknown.

Study Design

Retrospective cohort epidemiological study.

Setting

National Cancer Database, a hospital-based registry of over 1,500 facilities in the United States.

Patients

Adult VS patients (age, >18 years) treated surgically.

Interventions

High- versus low-volume facilities, defined using a facility case volume threshold of 25 cases per year. A risk-adjusted restricted cubic spline model was previously used to identify this risk threshold beyond which the incremental benefit of increasing case volume began to plateau.

Main Outcome Measures

Sociodemographic factors, including race, ethnicity, income, insurance status, and rurality. Multivariable analyses were adjusted for patient and tumor characteristics, including age, sex, Charlson–Deyo score, and tumor size.

Results

A totoal of 10,048 patients were identified (median [interquartile range] age = 51 [41–60] years, 54% female, 87% Caucasian). Patients with Spanish/Hispanic ethnicity (OR = 0.71, 95% confidence interval [CI] = 0.52–0.96), income below median (OR = 0.63, 95% CI = 0.55–0.73]), and Medicare, Medicaid, or other government insurance versus private insurance (OR = 0.63, 95% CI = 0.53–0.74) had reduced odds of treatment at a high-volume facility. Further sensitivity analyses in which facility volume was operationalized continuously reinforced direction and significance of these associations.

Conclusions

Socioeconomic disparities exist in the propensity for VS patients to be treated at a high-volume facility. Further work is needed to understand the nature of these associations and whether interventions can be designed to mitigate them.
The Evolution of Worldwide Nurse-Led Cancer Research in the Last 2 Decades (2004–2022)
Authors: Molassiotis Alex , Yorke Janelle , McCarthy Alexandra L. , Wengstrom Yvonne , Gibson Faith , Abu-Odah Hammoda
Published: August 2023

Background

Research led by nurses has evolved rapidly over the last 2 decades globally. Assessing the work that has been conducted so far can help the specialty to strategically shape future directions of nurse-led cancer research.

Objective

The aim of this study was to provide a comprehensive, up-to-date synthesis of all nurse-led cancer research published articles over 20 years.

Methods

A bibliometric analysis was used. Three databases were used to retrieve nurse-led cancer research publications for the period from January 1, 2004, to March 11, 2022.

Results

A total of 7043 original articles were retrieved. A significant increase in nurse-led cancer research over the past 2 decades was evident. The United States and United Kingdom were the most productive countries in terms of the number of published articles. Minimal international collaboration was observed among low- or middle-income countries versus high-income countries. Breast cancer, palliative care, and quality of life received the most attention in nurse-led cancer research, followed by education, pain, and communication. Very few publications addressed cancer prevention, breaking bad news, and cancer rehabilitation.

Conclusion

Areas to consider in the future include more international collaborations on commonly agreed research agendas, capacity building to allow more research beyond the few countries that dominate the publications, and more focus on low- or middle-income countries.

Implications for Practice

The findings of this study provide direction for future research led by cancer nurses and the areas that warrant further investigation.
Relationship Between Cortisol Rhythm and Psychoneurological Symptom Cluster in Patients With Advanced Lung Cancer
Authors: Takemura Naomi , Cheung Denise Shuk Ting , Fong Daniel Yee Tak , Ho Mu-Hsing , Lin Chia-Chin
Published: August 2023

Background

Patients with advanced lung cancer commonly experience a high prevalence of physical and psychological symptoms, which tend to co-occur as a symptom cluster. Cortisol rhythm has the potential to influence psychoneurological symptom cluster based on neuroendocrine-immune models; however, little is known about the relationship between them.

Objective

To examine the intercorrelation among symptoms in psychoneurological symptom cluster and the factors influencing the severity of psychoneurological symptom cluster.

Methods

One hundred sixty-one patients with advanced lung cancer were recruited from 2018 to 2020 as part of a large study. Data on sleep disturbances, fatigue, and psychological distress were collected via self-report questionnaires, and the diurnal cortisol slope was analyzed using saliva samples. Linear regression analyses were adopted to examine the association between cortisol rhythm and demographic and clinical variables with psychoneurological symptom cluster.

Results

Psychoneurological symptoms (including sleep disturbances, fatigue, anxiety, and depression) were significantly correlated. Poor physical performance status (β = −0.061, P < .001), increased number of comorbidities (β = 0.533, P < .001), and flatter cortisol rhythm (β = 545.092, P < .001) were significantly associated with higher-severity psychoneurological symptom cluster. Diurnal cortisol slope (β = 328.829, P = .025) was identified as the most critical factor influencing the psychoneurological symptom cluster in multiple linear regression model after adjusting for covariates.

Conclusions

Patients with flatter diurnal cortisol slopes were found to experience more severe psychoneurological symptom cluster, after controlling for demographic and clinical factors.

Implications for Practice

Interventions targeting the improvement of associated factors, such as comorbidities and physical performance status, could potentially alleviate the severity of the psychoneurological symptom cluster.
Investigating the Small Pixel Effect in Ultra-High Resolution Photon-Counting CT of the Lung
Authors: Huflage Henner , Hendel Robin , Kunz Andreas Steven , Ergün Süleyman , Afat Saif , Petri Nils , Hartung Viktor , Gruschwitz Philipp , Bley Thorsten Alexander , Grunz Jan-Peter
Published: August 2023

Objectives

The aim of this study was to investigate potential benefits of ultra-high resolution (UHR) over standard resolution scan mode in ultra-low dose photon-counting detector CT (PCD-CT) of the lung.

Materials and Methods

Six cadaveric specimens were examined with 5 dose settings using tin prefiltration, each in UHR (120 × 0.2 mm) and standard mode (144 × 0.4 mm), on a first-generation PCD-CT scanner. Image quality was evaluated quantitatively by noise comparisons in the trachea and both main bronchi. In addition, 16 readers (14 radiologists and 2 internal medicine physicians) independently completed a browser-based pairwise forced-choice comparison task for assessment of subjective image quality. The Kendall rank coefficient (W) was calculated to assess interrater agreement, and Pearson's correlation coefficient (r) was used to analyze the relationship between noise measurements and image quality rankings.

Results

Across all dose levels, image noise in UHR mode was lower than in standard mode for scan protocols matched by CTDIvol(P< 0.001). UHR examinations exhibited noise levels comparable to the next higher dose setting in standard mode (P≥ 0.275). Subjective ranking of protocols based on 5760 pairwise tests showed high interrater agreement (W= 0.99;P≤ 0.001) with UHR images being preferred by readers in the majority of comparisons. Irrespective of scan mode, a substantial indirect correlation was observed between image noise and subjective image quality ranking (r= −0.97;P≤ 0.001).

Conclusions

In PCD-CT of the lung, UHR scan mode reduces image noise considerably over standard resolution acquisition. Originating from the smaller detector element size in fan direction, the small pixel effect allows for superior image quality in ultra-low dose examinations with considerable potential for radiation dose reduction.
Hemodynamics Indicates Differences Between Patients With And Without A Stroke Outcome After Left Ventricular Assist Device Implantation
Authors: Sahni Akshita , Majee Sreeparna , Pal Jay D. , McIntyre Erin E. , Cao Kelly , Mukherjee Debanjan
Published: August 2023

Stroke remains a leading cause of complications and mortality in heart failure patients treated with a Left Ventricular Assist Device (LVAD). Hemodynamics plays a central role underlying post-LVAD stroke risk and etiology. Yet, detailed quantitative assessment of hemodynamic variables and their relation to stroke outcomes in patients on LVAD support remains a challenge. Modalities for pre-implantation assessment of post-implantation hemodynamics can help address this challenge. We present an in silico hemodynamics analysis for a digital twin cohort 12 patients on LVAD support; 6 with reported stroke outcomes and 6 without. For each patient we created a post-implant twin with the LVAD outflow graft reconstructed from cardiac-gated CT images; and a pre-implant twin of an estimated baseline flow by removing the LVAD outflow graft and driving flow from the aortic valve opening. Hemodynamics was characterized using descriptors for helical flow, vortex generation, and wall shear stress. We observed higher average values for descriptors of positive helical flow, vortex generation, and wall shear stress, across the 6 cases with stroke outcomes when compared with cases without stroke. When the descriptors for LVAD-driven flow were compared against estimated pre-implantation flow, extent of positive helicity was higher, and vorticity and wall shear were lower in cases with stroke compared to those without. Our study suggests that quantitative analysis of hemodynamics after LVAD implantation; and hemodynamic alterations from a pre-implant flow scenario, can potentially reveal hidden information linked to stroke outcomes during LVAD support. This has broad implications on understanding stroke etiology; and using patient digital twins for LVAD treatment planning, surgical optimization, and efficacy assessment.
Exploring the Pitfalls of Large Language Models: Inconsistency and Inaccuracy in Answering Pathology Board Examination-Style Questions
Authors: Koga Shunsuke
Published: August 2023

In the rapidly advancing field of artificial intelligence, large language models (LLMs) such as ChatGPT and Google Bard are making significant progress, with applications extending across various fields, including medicine. This study explores their potential utility and pitfalls by assessing the performance of these LLMs in answering 150 multiple-choice questions, encompassing 15 subspecialties in pathology, sourced from thePathologyOutlines.comQuestion Bank, a resource for pathology examination preparation. Overall, ChatGPT outperformed Google Bard, scoring 122 out of 150, while Google Bard achieved a score of 70. Additionally, we explored the consistency of these LLMs by applying a test-retest approach over a two-week interval. ChatGPT showed a consistency rate of 85%, while Google Bard exhibited a consistency rate of 61%. In-depth analysis of incorrect responses identified potential factual inaccuracies and interpretive errors. While LLMs have potential to enhance medical education and assist clinical decision-making, their current limitations underscore the need for continued development and the critical role of human expertise in the application of such models.