bluuebunny/crossref_metadata_2025 huggingface dataset:
An Integrative Review of the Support Needs of Informal Caregivers of Hematological Cancer Patients in the Period Immediately Following Discharge From Inpatient to Outpatient Care
Authors: Brunt Laura J. , Rivalland Alexandra , Panek-Hudson Yvonne , Krishnasamy Meinir
Published: November 2023

Background

Preparing informal caregivers for a patient’s transition to outpatient care is an important component of safe, quality hematological cancer care. The development of many novel therapies and emerging treatments has created opportunities to address the needs of informal caregivers following the discharge of patients from inpatient settings.

Objective

To review and synthesize the literature on the needs of informal caregivers of patients with a hematological malignancy postdischarge from inpatient care.

Interventions/Methods

Integrative review methodology was used to explore the body of evidence available. This included a quality appraisal of qualitative, quantitative, and mixed-methods research findings, subsequent data extraction, and inductive thematic synthesis.

Results

One thousand eight articles were screened with 10 included in the review. Key insights into the needs of caregivers entering the outpatient setting were identified and grouped into key subheadings: Encountering complex emotions knowing what to know, little time for yourself, and collateral impact.

Conclusion

Findings convey the complex and multiple needs of informal caregivers of hematological cancer patients. With a growing population of people with hematological malignancies and innovations in outpatient cancer therapies, there is a pressing need to codesign interventions to support their caregivers.

Implications for Practice

This review has identified a need for more robust research to coproduce interventions in collaboration with caregivers. In addition, interventions developed from further research should be tested in quality implementation science studies to determine their feasibility, sustainability, and impact on outcomes that matter to hematological cancer caregivers.
Rumination, Basic Beliefs, and Posttraumatic Growth in Cancer Patients
Authors: Gür Ganime C. , Öztürk Fatma Ö.
Published: November 2023

Background

Cancer is a highly distressing and traumatic experience that can significantly impact individuals’ psychological well-being. Whereas many cancer patients may experience negative psychological outcomes, such as posttraumatic stress symptoms, a subset of individuals also reports positive psychological changes known as posttraumatic growth.

Objective

To contribute to theory-driven development of these treatments by exploring the role of deliberate rumination in posttraumatic growth, along with the basic beliefs that might shape it.

Methods

A sample of cancer patients (n = 139) completed self-report measures assessing rumination, basic beliefs, and posttraumatic growth. Multiple linear regression analyses and moderated mediation models were conducted to analyze the data.

Results

Findings support the hypothesis that intrusive rumination, deliberate ruminating, and disruption in basic beliefs strongly predict posttraumatic growth in cancer survivors. The results of this simple mediation indicate that deliberate rumination has a full mediating role. The results show that at all levels of basic beliefs, there is a positive and statistically significant indirect effect of intrusive rumination on posttraumatic growth.

Conclusions

These findings highlight the importance of addressing rumination and core beliefs in interventions aimed at promoting posttraumatic growth among cancer patients. Further research is needed to explore additional factors that may influence the relationship between rumination, basic beliefs, and posttraumatic growth.

Implications for Practice

Oncology nurses can assist individuals in recognizing and managing intrusive rumination, as well as advocating deliberate rumination as a constructive cognitive process for making sense of a traumatic event and fostering growth.
Development and Validation of a Model for Endotracheal Intubation and Mechanical Ventilation Prediction in PICU Patients*
Authors: Chanci Daniela , Grunwell Jocelyn R. , Rafiei Alireza , Moore Ronald , Bishop Natalie R. , Rajapreyar Prakadeshwari , Lima Lisa M. , Mai Mark , Kamaleswaran Rishikesan
Published: November 2023

OBJECTIVES:

To develop and externally validate an intubation prediction model for children admitted to a PICU using objective and routinely available data from the electronic medical records (EMRs).

DESIGN:

Retrospective observational cohort study.

SETTING:

Two PICUs within the same healthcare system: an academic, quaternary care center (36 beds) and a community, tertiary care center (56 beds).

PATIENTS:

Children younger than 18 years old admitted to a PICU between 2010 and 2022.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Clinical data was extracted from the EMR. PICU stays with at least one mechanical ventilation event (≥ 24 hr) occurring within a window of 1–7 days after hospital admission were included in the study. Of 13,208 PICU stays in the derivation PICU cohort, 1,175 (8.90%) had an intubation event. In the validation cohort, there were 1,165 of 17,841 stays (6.53%) with an intubation event. We trained a Categorical Boosting (CatBoost) model using vital signs, laboratory tests, demographic data, medications, organ dysfunction scores, and other patient characteristics to predict the need of intubation and mechanical ventilation using a 24-hour window of data within their hospital stay. We compared the CatBoost model to an extreme gradient boost, random forest, and a logistic regression model. The area under the receiving operating characteristic curve for the derivation cohort and the validation cohort was 0.88 (95% CI, 0.88–0.89) and 0.92 (95% CI, 0.91–0.92), respectively.

CONCLUSIONS:

We developed and externally validated an interpretable machine learning prediction model that improves on conventional clinical criteria to predict the need for intubation in children hospitalized in a PICU using information readily available in the EMR. Implementation of our model may help clinicians optimize the timing of endotracheal intubation and better allocate respiratory and nursing staff to care for mechanically ventilated children.
Echinococcal Cyst Rupture in a 3-Year-Old Boy With a Minor Abdominal Trauma Identified by a Point-of-Care Ultrasound E-Fast Examination: A Case Report and Literature Review
Authors: Halevy Jonathan , Test Gidon , Kaplan Or , Kestenbom Inbal
Published: November 2023

Point-of-care ultrasound is now widely used in adult and pediatric emergency departments as part of the rapid evaluation and treatment of patients in urgent care settings. It has been shown to be a powerful tool to aid in decision making in both trauma and acute medical situations. We describe a case of a 3-year-old boy who presented with abdominal pain and fever after a minor abdominal trauma, highlighting the use of point-of-care ultrasound to arrive at the diagnosis of a ruptured echinococcal cyst.
Health Care Policy and Disparities in Health
Authors: Lansey Dina George , Ramalingam Rohan , Brawley Otis W.
Published: November 2023

The United States has seen a 33% decline in age-adjusted cancer mortality since 1991. Despite this achievement, the United States has some of the greatest health disparities of any developed nation. US government policies are increasingly directed toward reducing health disparities and promoting health equity. These policies govern the conduct of research, cancer prevention, access, and payment for care. Although implementation of policies has played a significant role in the successes of cancer control, inconsistent implementation of policy has resulted in divergent outcomes; poorly designed or inadequately implemented policies have hindered progress in reducing cancer death rates and, in certain cases, exacerbated existing disparities. Examining policies affecting cancer control in the United States and realizing their unintended consequences are crucial in addressing cancer inequities.
Diversity and Disparities in Lung Cancer Outcomes Among Minorities
Authors: Theik Nyein Wint Yee , Uribe Carlos Carracedo , Alvarez Andres , Muminovic Meri , Raez Luis E.
Published: November 2023

Because of diversities and disparities, lung cancer incidence and mortality rates among minorities are disproportionate compared with non-Hispanic White (NHW) populations. This review focuses on the disparities in lung cancer screening, diagnosis, treatment, and outcomes that minorities, mainly Hispanic and Black, experience compared with NHW populations. Despite efforts such as improving the eligibility criteria for screening to improve lung cancer survival rates, disparities persist, particularly among minority populations. However, the “Hispanic Paradox” describes the lower incidence and better survival rates observed in Hispanics compared with other ethnic groups best explained by possible contributions such as genetics and other factors such as dietary habits. Disparities in screening, particularly among underrepresented populations, are frequently explained by cultural, socioeconomic, and health care access barriers. There are also disparities in receiving appropriate treatment, such as surgical treatment, with fewer Hispanics and Blacks undergoing surgery than NHW individuals, resulting in lower overall survival rates. In addition, the prevalence of biomarker testing varies by racial and ethnic groups, influencing personalized treatment plans and outcomes. Finally, because of genetic and social determinants of health, the clinical outcomes of targeted therapy and immunotherapy may differ among minority populations. Identifying and addressing social determinants of health in real time are a “must” to have a significant impact in reducing lung cancer disparities. A comprehensive and multifaceted strategy is required to rectify disparities in cancer treatment. This strategy includes increasing levels of awareness and education, reducing financial and access barriers, and promoting increased diversity in clinical trial recruitment. By effectively addressing these complex challenges, the objective of providing equitable cancer care to all patients, regardless of race or ethnicity, can be achieved. To identify and address disparities, heightened awareness and education are essential. Access to health care is ensured by reducing financial and access barriers. Finally, increased diversity in clinical trial recruitment advances the generalizability of findings and promotes equitable representation of all racial and ethnic groups, resulting in improved outcomes for all patients.
Chlorine Gas Poisoning in an Aquatic Exercise Pool: A Case Report
Authors: Bell David L. , Keeton Krystal , Manzo Michael , May Easton
Published: November 2023

Background and Purpose:

This case report describes an incident of chlorine gas poisoning in an aquatic exercise class of senior adults in which 24 participants, facility employees, and first responders required emergency medical attention with some requiring hospitalization. The cause of the chlorine gas release, the health effects on participants, and the facility's subsequent response are described. The purpose of this case is to inform physical therapists and exercise professionals working in aquatic exercise pools about chlorine gas poisoning prevention and mitigation efforts.

Case Description:

The cause of this incident was a series of breakdowns in safety procedures leading to the release of chlorine gas while a class was in session. Because of limited exit points, physical debilitation of some participants, and a lack of proper safety equipment, the evacuation effort was delayed, overwhelming participants, facility employees, and first responders with toxic gas. Twenty-four people were transported to the emergency department with 7 hospitalized. At least 3 are known to suffer long-term health effects.

Outcomes:

The facility concluded that normal operating procedures and safety protocols were not followed. Following the review, the facility took measures to ensure adherence to proper procedures, revised its emergency action plan, and acquired the appropriate safety equipment.

Discussion:

The accidental release of chlorine gas in an exercise pool is a rare but potentially catastrophic event. Facilities operating exercise and aquatic therapy pools must follow strict protocols for the safe handling of pool chemicals and be prepared to respond immediately if a chlorine gas accident occurs. This case report serves as an example of risk management for the prevention of and response to a catastrophic release of chlorine gas during a group exercise or aquatic therapy session.
Effect of COVID-19 on Aquatic Physical Therapy Practice: What Have We Learned?
Authors: Van Wingerden Anita , Michaels Natalie Norman , Salem Yasser
Published: November 2023

Background:

Since the spring of 2020, the nation and international community have struggled with the task of being and remaining healthy, a task that before the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induced pandemic and global Public Health Emergency (PHE) for COVID-19, many of us took for granted. The SARS-CoV-2 virus has changed the face of health care, with many physical therapy clinics still using telehealth or virtual examinations that use a variety of online platforms. This could not be done with aquatic physical therapy (APT) intervention. APT is one area of health care where virtual reality was not a reality at all. The purpose of this survey was to assess the effect that the pandemic has had on APT in the United States from March 2020 to February 2022: what changed in APT during the pandemic and to what extent, what changes remain at present, what has worked well, what did not work at all, and what information would help aquatic physical therapists (APTs) and aquatic physical therapist assistants (APTAs) in the future.

Methods:

An anonymous survey was sent to all APTs and APTAs registered with the Academy of Aquatic Physical Therapy, with 45 respondents.

Results:

All 45 respondents had to stop working for a minimum of 2 weeks during the US-mandated quarantine. Only 11 of the 45 respondents were able to return to work in the aquatic setting over the ensuing months and some were laid off. It was not until March 2021 that most of these individuals (N = 35) were able to resume aquatic interventions with their patients. By February 2022, 7 of the respondents were still unable to provide APT intervention at their clinical sites.

Conclusion:

Only 20% of the 45 respondents reported satisfaction with the way things were handled at their clinical sites. Knowledge regarding preventing the spread of COVID-19 during the pandemic and the preventive measures required in an APT setting was obtained. Cessation of patient care, along with therapist layoffs, reveals a strong need for education in the field of APT for structured protocols that provide a safe means of continued aquatic intervention and provide confidence for aquatic physical therapists to safely continue APT with their patients.
Complications of Medical Tourism in Aesthetic Surgery
Authors: Alkaelani Mohammad Tahseen , Koussayer Bilal , Blount Taylor , Amawi Yusuf A. , Mahboob Omar , Le Nicole K. , Parus Anamaria , Troy Jared
Published: November 2023

Introduction

As medical cost continues to rise, so has the use of medical tourism by patients as a more cost-effective alternative. While the upfront cost savings attract many unsuspecting patients from their country of origin, there are significant patient safety issues surrounding short- and long-term follow-up, as well as the management and cost of complications.

Methods

A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses on complications that presented after cosmetic surgeries performed abroad. The literature search was performed on October 18, 2022, using the databases of PubMed, Google Scholar, and Embase.

Results

From the 44 studies that were included, 589 patients were identified who presented with complications after having a cosmetic procedure abroad. Infection was the most prevalent complication in this study followed by wound dehiscence, seroma/hematoma, and tissue necrosis. Ninety-eight percent of the infectious organisms were bacterial, and 81% of them were from the Mycobacterium genus.

Conclusions

Cosmetic tourism is a global phenomenon. This systematic review highlights the nature of complications following cosmetic tourism, the surgeries that resulted in complications, the countries that the primary procedures took place in, and the countries of origin of the patients. To aid in reducing morbidity and mortality from cosmetic tourism, regulatory bodies should educate and empower the public to aid them in making educated medical conditions when seeking care.
Abdominoplasty in a Patient With Type 3 von Willebrand Disease
Authors: Mert Sinan , Kuhlmann Constanze , Hagen Christine Sophie , Kessler Katharina , Balubaid Mohammed , Giunta Riccardo E. , Wiggenhauser Paul S.
Published: November 2023

von Willebrand disease (vWD) is an inherited bleeding disorder that is characterized by a quantitative or qualitative deficiency of the von Willebrand factor (vWF). Type 3 is the most severe form of vWD with a near-complete absence of vWF and a significantly increased risk of excessive bleeding and hematoma during a surgical procedure. To date, no data on surgical and hemostatic management of a type 3 vWD patient undergoing body-contouring surgery has been published. We report the case of a 47-year-old woman with type 3 vWD requiring medically indicated abdominoplasty after massive weight loss due to bariatric surgery. The case was successfully managed with individualized bodyweight-adapted substitution of recombinant vWF vonicog alfa and tranexamic acid under close monitoring of vWF and factor VIII activity. For further risk stratification, we propose the multidisciplinary treatment of patients with severe vWF undergoing elective plastic surgery in specialized centers providing around-the-clock laboratory testing and access to a blood bank. In addition, strict hemostasis during surgery and early postoperative mobilization with fitted compression garments are recommended to further reduce the risk of bleeding and thromboembolic complications.
Nerve Capping Techniques for Neuroma Management
Authors: Sisti Andrea , Uygur Safak , Lopez-Schultz Samson David , Konofaos Petros
Published: November 2023

Background/Aim of the Study

Nerve capping is a method of neuroma treatment or prevention that consists of the transplantation of a proximal nerve stump into an autograft or other material cap, after surgical removal of the neuroma or transection of the nerve. The aim was to reduce neuroma formation and symptoms by preventing neuronal adhesions and scar tissue. In this narrative literature review, we summarize the studies that have investigated the effectiveness of nerve capping for neuroma management to provide clarity and update the clinician's knowledge on the topic.

Methods

A systematic electronic search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria was performed in the PubMed database combining “neuroma,” “nerve,” “capping,” “conduit,” “treatment,” “management,” “wrap,” “tube,” and “surgery” as search terms. English-language clinical studies on humans and animals that described nerve capping as a treatment/prevention technique for neuromas were then selected based on a full-text article review. The data from the included studies were compiled based on the technique and material used for nerve capping, and technique and outcomes were reviewed.

Results

We found 10 applicable human studies from our literature search. Several capping materials were described: epineurium, nerve, muscle, collagen nerve conduit, Neurocap (synthetic copolymer of lactide and caprolactone, which is biocompatible and resorbable), silicone rubber, and collagen. Overall, 146 patients were treated in the clinical studies. After surgery, many patients were completely pain-free or had considerable improvement in pain scores, whereas some patients did not have improvement or were not satisfied after the procedure. Nerve capping was used in 18 preclinical animal studies, using a variety of capping materials including autologous tissues, silicone, and synthetic nanofibers. Preclinical studies demonstrated successful reduction in rates of neuroma formation.

Conclusions

Nerve capping has undergone major advancements since its beginnings and is now a useful option for the treatment or prevention of neuromas. As knowledge of peripheral nerve injuries and neuroma prevention grows, the criterion standard neuroprotective material for enhancement of nerve regeneration can be identified and applied to produce reliable surgical outcomes.
Vascularized Composite Allograft Versus Prosthetic for Reconstruction After Facial and Hand Trauma
Authors: Noel Olivier F. , Dumbrava Mihai G. , Daoud Deborah , Kammien Alexander J. , Kauke-Navarro Martin , Pomahac Bohdan , Colen David
Published: November 2023

In the past decade, vascularized composite allotransplantation (VCA) has become clinical reality for reconstruction after face and hand trauma. It offers patients the unique opportunity to regain form and function in a way that had only been achieved with traditional reconstruction or with the use of prostheses. On the other hand, prostheses for facial and hand reconstruction have continued to evolve over the years and, in many cases, represent the primary option for patients after hand and face trauma. We compared the cost, associated complications, and long-term outcomes of VCA with prostheses for reconstruction of the face and hand/upper extremity. Ultimately, VCA and prostheses represent 2 different reconstructive options with distinct benefit profiles and associated limitations and should ideally not be perceived as competing choices. Our work adds a valuable component to the general framework guiding the decision to offer VCA or prostheses for reconstruction after face and upper extremity trauma.
Lower-Extremity Fillet Flap for Reconstruction of Complex Stage IV Pressure Sores and Plantar Flap for Lumbosacral Padding
Authors: Turan Aydın
Published: November 2023

Background

The lower-extremity fillet flap is a suitable option for the repair of complex (multiple or complicated with osteomyelitis) stage IV pressure sores. If prepared from a nonfunctional extremity, it can close complex wounds and avoid the unnecessary burden of a nonfunctional organ that restricts patient movement, thereby improving quality of life.

Methods

We used a lower extremity fillet flap for reconstruction in 5 patients with complex stage IV pressure sores. The flaps were prepared from the nonfunctional lower extremity with multiple lesions by using iliofemoral disarticulation. The mean age of the patients was 60 years old, and the mean follow-up period was 18 months. A plantar flap was used in 1 patient for prophylactic padding of the lumbosacral region. In another patient, the plantar flap was used as a sensate flap.

Results

No major complications, such as total or partial flap loss, occurred in these patients. In 1 patient, a hematoma developed under the flap that led to dehiscence; however, it healed uneventfully without flap loss. Patients developed minimal pelvic stability and balance loss because of iliofemoral disarticulation, but it did not affect their sitting ability and mobility. After the operation, all patients became increasingly active and mobile because of the absence of excess weight on their nonfunctional legs, allowing them to easily perform daily activities such as turning in bed, using a wheelchair, eating, and dressing. Pressure sores did not develop in any of the patients during the postoperative follow-up period. The patient who underwent lumbosacral padding with a sensate plantar flap began to perceive touch over the flap in the fifth postoperative month.

Conclusions

These results suggest that a lower-extremity fillet flap can be a good repair option in complex stage IV pressure sores because it prevents recurrence and enables patients to perform daily activities more easily. Furthermore, plantar flaps can provide prophylactic padding in the lumbosacral region.
CIRC_0033530 KNOCKDOWN ALLEVIATES LIPOPOLYSACCHARIDE-INDUCED ACUTE LUNG INJURY MODEL OF HUMAN LUNG FIBROBLASTS BY MIR-1184/TLR4 AXIS
Authors: Xia Rui , Shan Yanhua , Luo Songyuan , Li Jiancheng , Liu Yongping
Published: November 2023

Background: Circular RNAs have been reported to be involved in regulating the progression of sepsis and sepsis-associated damage. Herein, this work investigated whether circ_0033530 had roles in the process of septic acute lung injury (sepsis-ALI) and its associated mechanism. Methods: Lipopolysaccharide (LPS)–stimulated human lung fibroblasts MRC-5 were used to mimic the cell model of sepsis-ALI in vitro. Levels of genes and proteins were detected by quantitative real-time polymerase chain reaction and Western blotting. Functional experiments were conducted using 5-ethynyl-2′-deoxyuridine assay, Cell Counting Kit-8 assay, flow cytometry, and enzyme-linked immunosorbent assay. The interaction between miR-1184 and circ_0033530 or toll-like receptor 4 (TLR4) was confirmed by dual-luciferase reporter and RNA immunoprecipitation assays. Results: Circ_0033530 expression was lower in sepsis patients and LPS-induced fibroblasts than those in healthy control and untreated cells. Functionally, knockdown of circ_0033530 protected fibroblasts against LPS-induced proliferation arrest, apoptosis, and inflammatory response. Mechanistically, circ_0033530 acted as a sponge for miR-1184, and TLR4 RNA was targeted by miR-1184, indicating the circ_0033530/miR-1184/TLR4 axis. Further rescue experiments showed that circ_0033530 silencing–mediated growth inhibition and inflammation on fibroblasts were attenuated by miR-1184 downregulation or TLR4 upregulation. Conclusion: Circ_0033530 knockdown alleviated LPS-induced proliferation arrest, apoptosis, and inflammation in lung fibroblasts by miR-1184/TLR4 axis, and provided molecular theoretical basis for circ_0033530 on the pathogenesis of sepsis-ALI.
Equol, a soybean metabolite with estrogen-like functions, decreases lipopolysaccharide-induced human neutrophil extracellular traps in vitro
Authors: Murakami Hiromoto , Ishikawa Michiko , Higashi Hideki , Kohama Keisuke , Inoue Taketo , Fujisaki Noritomo , Hirata Jun-ichi
Published: November 2023

Objective

Neutrophil extracellular traps (NETs) defend against acute infections. However, their overexpression causes organ failure during sepsis. Control of NET formation may improve the outcomes of patients with sepsis. Equol, a soybean isoflavone, is a female hormone analog, which prevents inflammation. We evaluated the effects of equol on NET formation in human neutrophils during inflammatory stimulation in vitro.

Methods

Healthy volunteers provided blood samples. An enzyme-linked immunosorbent assay (ELISA) assessed serum equol concentrations. NET formation in neutrophils was induced by lipopolysaccharide (LPS) treatment. ELISA quantified DNA-binding elastase, and immunostaining assessed NET formation. Reverse-transcription quantitative PCR and western blotting detected G-protein-coupled receptor 30 (GPR30) or peptidyl arginine deiminase 4 (PAD4) expression. Flow cytometry assessed neutrophil phagocytic ability with inactivated Escherichia coli.

Results

In neutrophils derived from males with low-serum equol levels (low-serum equol group), equol significantly decreased DNA-binding elastase levels and NET formation. Equol did not decrease NETs in neutrophils from males with high-serum equol levels. GPR30 expression of neutrophils was higher in the low-serum than in the high-serum equol group. PAD4 mRNA levels and nuclear PAD4 protein expression also decreased than the vehicle control in the low-serum equol group. Equol did not alter the phagocytic ability of neutrophils. In neutrophils from young females, equol had no inhibitory effect on NET formation.

Conclusions

Equol decreases LPS-induced NET formation in neutrophils from males via inhibition of PAD4 expression. Our findings provide a rationale for investigating a new therapeutic approach using equol to control neutrophil activity during sepsis.
Impact of Standard Versus Low Pneumoperitoneum Pressure on Peritoneal Environment in Laparoscopic Cholecystectomy. Randomized Clinical Trial
Authors: Serrano Ana Belén , Díaz-Cambronero Óscar , Montiel María , Molina José , Núñez Mónica , Mendía Elena , Mané María Nuria , Lisa Eduardo , Martínez-Botas Javier , Gómez-Coronado Diego , Gaetano Andrea , Casarejos María José , Gómez Ana , Sanjuanbenito Alfonso
Published: November 2023

Background:

High CO2 pneumoperitoneum pressure during laparoscopy adversely affects the peritoneal environment. This study hypothesized that low pneumoperitoneum pressure may be linked to less peritoneal damage and possibly to better clinical outcomes.

Materials and Methods:

One hundred patients undergoing scheduled laparoscopic cholecystectomy were randomized 1:1 to low or to standard pneumoperitoneum pressure. Peritoneal biopsies were performed at baseline time and 1 hour after peritoneum insufflation in all patients. The primary outcome was peritoneal remodeling biomarkers and apoptotic index. Secondary outcomes included biomarker differences at the studied times and some clinical variables such as length of hospital stay, and quality and safety issues related to the procedure.

Results:

Peritoneal IL6 after 1 hour of surgery was significantly higher in the standard than in the low-pressure group (4.26±1.34 vs. 3.24±1.21; P=0.001). On the contrary, levels of connective tissue growth factor and plasminogen activator inhibitor-I were higher in the low-pressure group (0.89±0.61 vs. 0.61±0.84; P=0.025, and 0.74±0.89 vs. 0.24±1.15; P=0.028, respectively). Regarding apoptotic index, similar levels were found in both groups and were 44.0±10.9 and 42.5±17.8 in low and standard pressure groups, respectively. None of the secondary outcomes showed differences between the 2 groups.

Conclusions:

Peritoneal inflammation after laparoscopic cholecystectomy is higher when surgery is performed under standard pressure. Adhesion formation seems to be less in this group. The majority of patients undergoing surgery under low pressure were operated under optimal workspace conditions, regardless of the surgeon’s expertise.
Acute pain management after trauma: What you need to know
Authors: Klugh James M. , Harvin John A.
Published: November 2023

Effective acute pain control is mandatory after injury. Opioids continue to be a pillar acute pain management of strategies despite not being as effective as some nonnarcotic alternatives. An acute pain management strategy after trauma should be thoughtful, effective, and responsible. A thoughtful approach includes managing a patient's expectations for acute pain control and ensuring that interventions purposefully and rationally affect the domain of pain that is uncontrolled. An effective pain management strategy includes a multimodal approach using acetaminophen, nonsteroidal anti-inflammatory drugs, and regional anesthesia. A responsible acute pain management approach includes knowing the relative strengths of the opioids prescribed and standardized approach to opioid prescribing at discharge to minimize diversion. Acute pain management is quite understudied, and future considerations include a reliable objective measurement of pain and the evaluation of nonmedication acute pain interventions.
Feasibility and safety of intraoperative bile duct clearance by antegrade transcystic balloon sphincteroplasty: A prospective observational pilot study
Authors: Prevost Gian Andrea , Huber Chantal , Schnell Bianca , Candinas Daniel , Wiest Reiner , Schnüriger Beat
Published: November 2023

BACKGROUND

Concomitant cholecystolithiasis and choledocholithiasis are common. Standard treatments are endoscopic retrograde cholangiography (ERC) followed by cholecystectomy or laparoendoscopic rendezvous. Endoscopic retrograde cholangiography has drawbacks, such as post-ERC pancreatitis or bleeding, and potentially more than one intervention is required to address common bile duct (CBD) stones. Safety and feasibility of an intraoperative antegrade transcystic single-stage approach during cholecystectomy with balloon sphincteroplasty and pushing of stones to the duodenum has not been evaluated prospectively. The aim of this pilot study was to evaluate this procedure regarding safety, feasibility, and stone clearance rate.

METHODS

Prospective single-center intervention study (SUPER Reporting-Guideline). Main inclusion criterion was confirmed choledocholithiasis (stones ≤6 mm) at intraoperative cholangiography. Success of the procedure was defined as CBD stone clearance at intraoperative control cholangiography, absence of symptoms and no elevated cholestasis parameters at 6 weeks follow-up. Simon’s two-stage design was used to determine sample size.

RESULTS

From January 2021 to April 2022, a total of 57 patients fulfilled the final inclusion criteria and were included. Mild pancreatitis or cholangitis were present upon admission in 15 (26%) and 15 (26%) patients, respectively. Median number of CBD-stones was 1 (1–6). Median stone diameter was 4 mm (0.1–6 mm). Common bile duct stone clearance was achieved in 54 patients (94%). The main reason for failed CBD clearance was the inability to push the guidewire along the biliary stone into the duodenum. Median intervention time was 28 minutes (14–129 minutes). While there was no postoperative pancreatitis, two patients (3.5%) had asymptomatic hyperlipasemia 4 hours postoperatively.

CONCLUSION

Intraoperative CBD stone clearance by antegrade balloon sphincteroplasty appears to be safe and highly feasible. Its overall superiority to the current standards warrants evaluation by a randomized controlled trial.

LEVEL OF EVIDENCE

Therapeutic/Care Management, Level V.
Association between transfusion volume and survival outcome following trauma: Insight into the limit of transfusion from an analysis of nationwide trauma registry in Japan
Authors: Shibahashi Keita , Aoki Makoto , Hikone Mayu , Sugiyama Kazuhiro
Published: November 2023

BACKGROUND

Whether and how the transfusion volume should be limited in resuscitation after trauma remains unclear. We investigated the association between transfusion volume and survival outcome following trauma.

METHODS

Using the Japan Trauma Data Bank (2019–2021), we identified patients 18 years or older who received balanced blood transfusion within the first 24 hours of injury. We evaluated the association between the total number of red blood cell (RBC) units transfused and survival at discharge using logistic regression analysis and generalized additive model. Subgroup analyses based on patient characteristics were performed.

RESULTS

Overall, 5,123 patients from 165 hospitals were eligible for analysis. The transfusion volume was significantly associated with survival rate. Compared with that of patients receiving 4 to 9 RBC units, the within-hospital odds ratios (95% confidence interval) for survival at discharge were 0.62 (0.55–0.75), 0.32 (0.25–0.40), and 0.15 (0.12–0.20) for those receiving 10 to 19, 20 to 29, and ≥30 U, respectively. The probability of survival decreased consistently without any discernible threshold; however, the survival rates remained >40% and >20% even in patients receiving 50 and 80 RBC units, respectively. Significant interactions were observed between the number of RBC units transfused and each subgroup for survival at discharge.

CONCLUSION

The probability of survival consistently diminished as the transfusion volume increased. The absence of a threshold and lack of exceedingly low probability of survival support massive transfusion when clinicians perceive ongoing transfusion as beneficial. The unique context of each clinical situation must be considered in decision making.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III.
Intramuscular Administration of Tranexamic Acid in a Large Swine Model of Hemorrhage with Hyperfibrinolysis
Authors: Haberkorn Christopher J. , Severance Carter C. , Wetmore Nathan C. , West Walker G. , Ng Patrick C. , Cendali Francesca , Pitotti Christopher , Schauer Steven G. , Maddry Joseph K. , Bebarta Vikhyat S. , Hendry-Hofer Tara B.
Published: November 2023

Background

Traumatic injury with subsequent hemorrhage is one of the leading causes of mortality among military personnel and civilians alike. Post traumatic hemorrhage accounts for 40-50% of deaths in severe trauma patients occurring secondary to direct vessel injury or the development of trauma induced coagulopathy (TIC). Hyperfibrinolysis plays a major role in TIC and its presence increases a patient’s risk of mortality. Early therapeutic intervention with intravenous (IV) tranexamic acid (TXA) prevents development of hyperfibrinolysis and subsequent TIC leading to decreased mortality. However, obtaining IV access in an austere environment can be challenging. In this study, we evaluated the efficacy of intramuscular (IM) versus IV TXA at preventing hyperfibrinolysis in a hemorrhaged swine.

Methods

Yorkshire cross swine were randomized on the day of study to receive IM or IV TXA or no treatment. Swine were sedated, intubated, and determined to be hemodynamically stable prior to experimentation. Controlled hemorrhaged was induced by the removal of 30% total blood volume. After hemorrhage, swine were treated with 1000 mg of IM or IV TXA. Control animals received no treatment. Thirty minutes post TXA treatment, fibrinolysis was induced with a 50 mg bolus of tissue plasminogen activator (tPA). Blood samples were collected to evaluate blood TXA concentrations, blood gases, blood chemistry, and fibrinolysis.

Results

Blood TXA concentrations were significantly different between administration routes at the early timepoints, but were equivalent by 20 minutes after injection, remaining consistently elevated for up to three hours post administration. Induction of fibrinolysis resulted in 87.18 ± 4.63% lysis in control animals, compared to swine treated with IM TXA 1.96 ± 2.66 % and 1.5 ± 0.42% lysis in the IV TXA group.

Conclusion

In the large swine model of hemorrhage with hyperfibrinolysis, IM TXA is bioequivalent and equally efficacious in preventing hyperfibrinolysis as IV TXA administration.
Setting an agenda for a national pediatric trauma system: Operationalization of the Pediatric Trauma State Assessment Score
Authors: Stephens Caroline Q. , Fallat Mary E.
Published: November 2023

Pediatric trauma system development is essential to public health infrastructure and pediatric health systems. Currently, trauma systems are managed at the state level, with significant variation in consideration of pediatric needs. A recently developed Pediatric Trauma System Assessment Score (PTSAS) demonstrated that states with lower PTSAS have increased pediatric mortality from trauma. Critical gaps are identified within six PTSAS domains: Legislation and Funding, Access to Care, Injury Prevention and Recognition, Disaster, Quality Improvement and Trauma Registry, and Pediatric Readiness. For each gap, a recommendation is provided regarding the necessary steps to address these challenges. Existing national organizations, including governmental, professional, and advocacy, highlight the potential partnerships that could be fostered to support efforts to address existing gaps. The organizations created under the US administration are described to highlight the ongoing efforts to support the development of pediatric emergency health systems.

It is no longer sufficient to describe the disparities in pediatric trauma outcomes without taking action to ensure that the health system is equipped to manage injured children. By capitalizing on organizations that intersect with trauma and emergency systems to address known gaps, we can reduce the impact of injury on all children across the United States.
Translation and Transcription Processes in the Writing Skills of Children With Developmental Language Disorder
Authors: Williams Gareth J. , Larkin Rebecca F.
Published: November 2023

Children with difficulties in language learning experience considerable problems in writing and spelling. This systematic review explores the research literature that has been conducted with children who have language learning difficulties (developmental language disorder) through the lens of Chenoweth and Hayes' (2003) model of writing. The model proposes that, when writing, ideas are translated into language, are processed through an evaluator/reviser, and then undergo transcription. The results of the systematic review indicate a pattern of delay in the development of translation and transcription processes relative to chronologically age-matched peers. Findings are considered with reference to future directions in research and clinical and educational implications.
Persistent paramyxovirus infections: in co-infections the parainfluenza virus type 5 persistent phenotype is dominant over the lytic phenotype
Authors: Randall Richard E. , Young Dan F. , Hughes David J. , Goodbourn Steve
Published: November 2023

Parainfluenza virus type 5 (PIV5) can either have a persistent or a lytic phenotype in cultured cells. We have previously shown that the phenotype is determined by the phosphorylation status of the phosphoprotein (P). Single amino acid substitutions at critical residues, including a serine-to-phenylalanine substitution at position 157 on P, result in a switch between persistent and lytic phenotypes. Here, using PIV5 vectors expressing either mCherry or GFP with persistent or lytic phenotypes, we show that in co-infections the persistent phenotype is dominant. Thus, in contrast to the cell death observed with cells infected solely with the lytic variant, in co-infected cells persistence is immediately established and both lytic and persistent genotypes persist. Furthermore, 10–20 % of virus released from dually infected cells contains both genotypes, indicating that PIV5 particles can package more than one genome. Co-infected cells continue to maintain both genotypes/phenotypes during cell passage, as do individual colonies of cells derived from a culture of persistently infected cells. A refinement of our model on how the dynamics of virus selection may occur in vivo is presented.
High incidence of antibiotic resistance amongst isolates of Helicobacter pylori collected in Nottingham, UK, between 2001 and 2018
Authors: Garvey Elizabeth , Rhead Joanne , Suffian Suffi , Whiley Daniel , Mahmood Farah , Bakshi Naveen , Letley Darren , White Jonathan , Atherton John , Winter Jody Anne , Robinson Karen
Published: November 2023

Introduction.

Helicobacter pylori

is the leading cause of peptic ulcers and gastric cancer. The most common treatment regimens use combinations of two or three antibiotics and a proton pump inhibitor (PPI) to suppress stomach acid. The World Health Organization designated clarithromycin-resistant

H. pylori

as a high priority pathogen for drug development, due to increasing antibiotic resistance globally.

Hypothesis/Gap Statement. There is no routine surveillance of

H. pylori

primary antimicrobial sensitivities in the UK, and published data are lacking.

Aim. This study aimed to characterize antimicrobial sensitivities of isolates collected in Nottingham, UK, between 2001 and 2018.

Methodology. Gastric biopsy samples were collected, with informed written consent and ethics approval, from 162 patients attending the Queen’s Medical Centre in Nottingham for an upper GI tract endoscopy. Antibiotic sensitivity was assessed using E-Tests and a more cost-effective disc diffusion test.

Results. The clarithromycin, amoxicillin and levofloxacin disc diffusion tests provided identical results to E-Tests on a subset of 30 isolates. Disparities were observed in the metronidazole test results, however. In total, 241 isolates from 162 patients were tested using at least one method. Of all isolates, 28 % were resistant to clarithromycin, 62 % to metronidazole and 3 % to amoxicillin, which are used in first-line therapies. For those antibiotics used in second- and third-line therapies, 4 % were resistant to levofloxacin and none of the isolates were resistant to tetracycline. Resistance to more than one antibiotic was found in 27 % of isolates. The frequency of patients with a clarithromycin-resistant strain increased dramatically over time: from 16 % between 2001 and 2005 to 40 % between 2011 and 2018 (P=0.011). For the same time periods, there was also an increase in those with a metronidazole-resistant strain (from 58 to 78 %; P=0.05). The frequencies of clarithromycin and metronidazole resistance were higher in isolates from patients who had previously received eradication therapy, compared to those who had not (40 % versus 77 %, and 80 % versus 92 %, respectively). Of 79 pairs of isolates from the antrum and corpus regions of the same patient’s stomach, only six had differences in their antimicrobial susceptibility profiles.

Conclusion. Although there was high and increasing resistance to clarithromycin and metronidazole, there was no resistance to tetracycline and the frequencies of amoxicillin and levofloxacin resistance were very low.
A Method for Analyzing AFM Force Mapping Data Obtained from Soft Tissue Cryosections
Authors: Wong Cydney A. , Fraticelli Guzmán Nina Sara , Read A. Thomas , Hedberg-Buenz Adam , Anderson Michael G. , Feola Andrew J. , Sulchek Todd , Ethier C. Ross
Published: November 2023

Atomic force microscopy (AFM) is a valuable tool for assessing mechanical properties of biological samples, but interpretations of measurements on whole tissues can be difficult due to the tissue’s highly heterogeneous nature. To overcome such difficulties and obtain more robust estimates of tissue mechanical properties, we describe an AFM force mapping and data analysis pipeline to characterize the mechanical properties of cryosectioned soft tissues. We assessed this approach on mouse optic nerve head and rat trabecular meshwork, cornea, and sclera. Our data show that the use of repeated measurements, outlier exclusion, and log-normal data transformation increases confidence in AFM mechanical measurements, and we propose that this methodology can be broadly applied to measuring soft tissue properties from cryosections.
Utility of T1 mapping and T2 mapping for non-invasive assessment of liver fibrosis: preclinical results
Authors: Rong Jing , Zhu Yujie , Zhu Kun , Shao Min , Yin Xiujuan , Liu Tongtong , Wang Xiao
Published: November 2023

Objective

To explore the potential of T1 and T2 mappings in assessing liver fibrosis (LF) and investigate the relationships between MRI and liver fibrogenesis markers.

Materials and methods A total of 39 male C57BL/6 mice were divided into the control group (n = 9) and the model group (n = 10 per subgroup) with carbon tetrachloride (CCl4) administration for 2, 4, and 6 weeks. The METAVIR system (F0-4) was performed to stage fibrosis. MRI T1 and T2 mappings were performed and T1, and T2 values were calculated. One-way analysis of variance (ANOVA), Spearman’s rank correlation analysis, and receiver operating characteristic (ROC) curves were performed.

Results

T1 and T2 values increased with progressing severity of fibrosis induction (P< 0.01). T1 and T2 were significantly correlated with LF stages (ρ = 0.854, 0.697,P< 0.001). The area under the curves (AUCs) range of T1 and T2 for predicting ≥F1, ≥F2, ≥F3, and F4 were 0.842-0.994 and 0.808-0.883, respectively. T1 and T2 showed moderate to strong correlations with collagen-associated protein and inflammatory factors.

Discussion

T1 and T2 mappings can evaluate and differentiate LF stages in the CCl4-induced model. T1 is better correlated with collagen deposition and inflammation of LF than T2.