bluuebunny/crossref_metadata_2025 huggingface dataset:
A Modification to the Situation-based Scheme for Sorting Exposures Proposed in ICRP Publication 103
Authors: Chi Yun C.
Published: December 2021

The International Commission on Radiological Protection (ICRP) issued its current recommendations in 2007, introducing an evolution from a previously process-based protection approach (practices and interventions) to a situation-based approach (planned, existing, and emergency). In most countries, radiation protection standards are generally in line with the new recommendations by the ICRP. Unfortunately, in many cases, situations involving sources of natural or artificial origin may be in a state of contradiction. Logical incompleteness and unsoundness in the framework of exposure situations can be found in current ICRP recommendations. There are situations that do not readily fall into any category. To contribute to a more reasonable situation-based approach for the radiological protection community, we recommend here a possible framework of exposure situations, i.e., planned, unplanned, and naturally occurring, that forms one coherent system. We believe this system will provide increased clarity that will help resolve possible sorting problems.
Estimation of the Thyroid Equivalent Doses to Residents in Areas Affected by the 2011 Fukushima Nuclear Disaster Due to Inhalation of 131I Based on Their Behavioral Data and the Latest Atmospheric Transport and Dispersion Model Simulation
Authors: Kim Eunjoo , Igarashi Yu , Hashimoto Shozo , Tani Kotaro , Kowatari Munehiko , Ishikawa Tetsuo , Kurihara Osamu
Published: December 2021

It has been challenging to obtain reliable estimates of thyroid equivalent doses (TEDs) to residents involved in the 11 March 2011 Fukushima Daiichi Nuclear Power Plant (FDNPP) accident because of the shortage of direct human measurements associated with 131I, the largest contributor to the dose of concern. The present study attempted to perform the estimation of the TEDs by inhalation of 131I to residents from Namie-town, one of the most radiologically-affected municipalities, by means of the latest atmospheric transport and dispersion model (ATDM) simulations with the Worldwide version of System for Prediction of Environmental Emergency Dose Information (WSPEEDI) ver. 2, coupled with personal behavioral data containing the history of the whereabouts of individuals shortly after the accident. We analyzed 1,637 residents who underwent direct measurements with whole-body counters several months after the accident and provided their personal behavioral data. We divided the subjects into two groups based on whether the distances between their locations and the FDNPP were >20 km as of 15:00 on 12 March in relation to the timepoint of the hydrogen explosion at the Unit 1 Reactor building. As a result, the 90th percentile TEDs of the 1,249 prompt evacuees and 388 late evacuees were 3.9 mSv (adult)–6.8 mSv (10-y-old) and 24.1 mSv (adult)–35.6 mSv (5-y-old), respectively, excluding 16 persons whose TEDs exceeded 50 mSv. The 90th percentile (median) TEDs to 1-y-old children (not included in the subjects) for the prompt and late evacuation groups were 8.1 (1.0) mSv and 36.3 (19.7) mSv, respectively. Additionally, this study provided the evidence to support the view that the explosive event at the Unit 1 Reactor building on the afternoon of 12 March 2011 could have caused the critical group among Namie-town's residents, whereas the largest release event on 15 March gave relatively small doses to the residents because their exposure took place mostly at sites that were distant from the FDNPP. However, the present dose estimation has potentially large uncertainty at the individual level; further validations are thus necessary.
CHOROIDAL NEOVASCULAR MEMBRANE ASSOCIATED WITH CHOROIDAL LYMPHOMA
Authors: Ebert Jared J. , Di Nicola Maura , Williams Basil K.
Published: December 2021

Purpose:

A patient with choroidal lymphoma associated with a choroidal neovascular membrane (CNVM) is described.

Methods:

Observational case report.

Results:

A 70-year-old man was referred for evaluation of bilateral uveitis with concern for intraocular lymphoma. Fundoscopic examination was notable for vitreous opacities and diffuse yellow–white, creamy choroidal infiltrates in both eyes. In the left eye, areas of hemorrhage and intraretinal fluid in the macula consistent with a CNVM were noted. Multimodal imaging confirmed the diagnosis of bilateral choroidal lymphoma with a CNVM in the left eye. The patient subsequently underwent external beam radiation therapy. The CNVM was treated with intravitreal bevacizumab.

Conclusion:

This case highlights the rare finding of a patient with a CNVM associated with choroidal lymphoma. Recognition and treatment of concurrent disease processes in the setting of choroidal lymphoma is important to achieve maximum visual potential.
Dermatoscopy in the Diagnosis of Vulvar Basal Cell Carcinoma: A Case Report
Authors: de los Cobos Davaios Diego Adolfo , Cepeda-Valdes Rodrigo , Favela-Fernandez Luis Fernando , Villarreal-Carrillo Claudia , Salas-Alanis Julio Cesar
Published: December 2021

Introduction:

Basal cell carcinoma (BCC) is the most common human malignancy commonly in white people, but in less than 1% of cases it may appear on unexposed areas, like the perineal and anal regions. Vulvar BCC is often diagnosed late because it grows slowly and tends to be asymptomatic, with no specific physical findings.

Here, we present a rare Latin patient with a 10-year history of vulvar BCC with dermatoscopic and histopathologic findings.

Case report:

A 65-year-old Latin woman presented with a nodule on her left labium majus, which she first noted 10 years ago, and that had grown slowly but constantly. She also reported a 20-year history of pruritus and occasional pain. Physical examination showed a 3.5 cm × 3.0 cm erythematous lesion with a central rough without inguinal lymphadenopathy. Contact dermatoscopy (Dermalite DL3 Gen.) showed one blurred cluster of arborising vessels in a pinkish background with white homogeneous areas and lines radial converging. An incisional biopsy was realized, and histopathology diagnosed BCC.

Discussion:

Vulvar BCC is a rare malignancy that affects mainly Caucasian women over 70 years of age. The most common etiology for BCC is ultraviolet radiation, but as the vulva is unexposed its cause is unclear. Mutations in tumor suppressor and regulatory genes such as p53 are present in 50% of cases. Gorlin syndrome, chronic radiation, chronic arsenic exposure, xeroderma pigmentosum, and immunosuppression have been considered as risk factors.

Conclusion:

Vulvar BCC characteristics are the same as other cutaneous forms, featuring blue ovoid nests and arborizing telangiectasia, confused with inflammatory diseases, such as eczema, psoriasis, and chronic infection (especially if it is accompanied by pruritus), this makes diagnosis complex, with a delay of 5 to 6 years on average, with an average size of 2.1 cm. Diagnosis is enhanced with dermatoscopy, as the preferred treatment for most BCC cases is wide surgical excision.
Survival and Factors Associated with Survival with Extracorporeal Life Support During Cardiac Arrest: A Systematic Review and Meta-Analysis
Authors: Panagides Vassili , Laine Marc , Fond Guillaume , Lebreton Guillaume , Paganelli Franck , Michelet Pierre , Roch Antoine , Boyer Laurent , Bonello Laurent
Published: December 2021

The survival rate after cardiac arrest (CA) remains low. The utilization of extracorporeal life support is proposed to improve management. However, this resource-intensive tool is associated with complications and must be used in selected patients. We performed a meta-analysis to determine predictive factors of survival. Among the 81 studies included, involving 9256 patients, survival was 26.2% at discharge and 20.4% with a good neurologic outcome. Meta-regressions identified an association between survival at discharge and lower lactate values, intrahospital CA, and lower cardio pulmonary resuscitation (CPR) duration. After adjustment for age, intrahospital CA, and mean CPR duration, an initial shockable rhythm was the only remaining factor associated with survival to discharge (β = 0.02, 95% CI: 0.007–0.02; p = 0.0004).
Construction and Evaluation of a Bio-Engineered Pump to Enable Subpulmonary Support of the Fontan Circulation: A Proof-of-Concept Study
Authors: Broda Christopher R. , Smith P. Alex , Wang Yaxin , Sriraman Hamsini , Owuor Peter S. , Sampaio Luiz C. , Adachi Iki , Taylor Doris A.
Published: December 2021

Our objective was to create a bio-engineered pump (BEP) for subpulmonary Fontan circulation support capable of luminal endothelialization and producing a 2–6 mmHg pressure gradient across the device without flow obstruction. To accomplish this, porcine urinary bladder submucosa was decellularized to produce a urinary bladder matrix (UBM) which produced acellular sheets of UBM. The UBM was cultured with human umbilical vein endothelial cells producing a nearly confluent monolayer of cells with the maintenance of typical histologic features demonstrating UBM to be a suitable substrate for endothelial cells. A lamination process created bilayer UBM sheets which were formed into biologic reservoirs. BEPs were constructed by securing the biologic reservoir between inlet and outlet valves and compressed with a polyurethane balloon. BEP function was evaluated in a simple flow loop representative of a modified subpulmonary Fontan circulation. A BEP with a 92-mL biologic reservoir operating at 60 cycles per minute produced pulsatile downstream flows without flow obstruction and generated a favorable pressure gradient across the device, maintaining upstream pressure of 6 mm Hg and producing downstream pressure of 13 mm Hg. The BEP represents potential long-term assistance for the Fontan circulation to relieve venous hypertension, provide pulsatile pulmonary blood flow and maintain cardiac preload.
In Vivo Evaluation of a Physiologic Control System for Rotary Blood Pumps Based on the Left Ventricular Pressure-Volume Loop
Authors: Cysyk Joshua , Jhun Choon-Sik , Newswanger Ray , Pae Walter , Izer Jenelle , Flory Heidi , Reibson John , Weiss William , Rosenberg Gerson
Published: December 2021

Current generation continuous flow assist devices to operate at a fixed speed, which limits preload response and exercise capacity in left ventricular assist device (LVAD) patients. A feedback control system was developed to automatically adjust pump speed based on direct measurements of ventricular loading using a custom cannula tip with an integrated pressure sensor and volume-sensing conductance electrodes. The input to the control system is the integral of the left ventricular (LV) pressure versus conductance loop (PGA) over each cardiac cycle. The feedback control system adjusts pump speed based on the difference between the measured PGA and the desired PGA. The control system and cannula tip were tested in acute ovine studies (n = 5) using the HeartMate II LVAD. The preload response of the control system was evaluated by partially occluding and releasing the inferior vena cava using a vessel loop snare. The cannula tip was integrated onto a custom centrifugal flow LVAD and tested in a 14-day bovine study. The control system adjusted pump support to maintain constant ventricular loading: pump speed increased (decreased) following an increase (decrease) in preload. This study demonstrated in vivo the Starling-like response of an automatic pump control system based on direct measurements of LV loading.
Predictors of Favorable Neurologic Outcomes in a Territory-First Extracorporeal Cardiopulmonary Resuscitation Program
Authors: Ng Pauline Yeung , Li Andy Chak Cheung , Fang Shu , Lin Jeremy Chang Rang , Ip April , Chan Wai Ming , Sin Wai Ching , Ngai Chun Wai
Published: December 2021

Extracorporeal cardiopulmonary resuscitation (ECPR) is an advanced resuscitation method that has been associated with better outcomes after cardiac arrest compared with conventional cardiopulmonary resuscitation. This is a retrospective analysis of all patients who received ECPR for cardiac arrest in Hong Kong’s first ECPR program from 2012 to 2020. The primary outcome was favorable neurologic outcome at 3 months. A new risk prediction model was developed and its performance was compared with published risk scores. One-hundred two patients received ECPR and 19 (18.6%) patients survived with favorable neurologic outcome. Having a shockable rhythm was the strongest predictor of favorable neurologic outcome in multivariate analysis (odds ratio, 9.64; 95% confidence interval [CI], 1.49 to 62.30; P = 0.017). We developed a simple model with three parameters for the prediction of favorable neurologic outcomes – presence of shockable rhythm, mean arterial pressure after extracorporeal membrane oxygenation, and the Acute Physiology And Chronic Health Evaluation IV score, with an area under receiver operating characteristic curve of 0.85 (95% CI, 0.77 to 0.94). In Hong Kong’s first ECPR program, 18.6% patients survived with favorable neurologic outcomes, and having a shockable rhythm at presentation was the strongest predictor. Risk scores are useful in predicting important patient outcomes and should be included in clinical decision-making for patients who received ECPR.
End-stage Renal Disease and Long-term Survival Among Survivors of Extracorporeal Membrane Oxygenation
Authors: Oh Tak Kyu , Kim Sejoong , Song In-Ae
Published: December 2021

We aimed to investigate the prevalence and associated factors of newly diagnosed end-stage renal disease (ESRD) requiring renal-replacement therapy (RRT) among survivors of extracorporeal membrane oxygenation (ECMO) and determine whether newly diagnosed ESRD is associated with poorer long-term survival outcomes. All adult patients who underwent ECMO between 2005 and 2018 were included, and ECMO survivors were those who survived more than 365 days after ECMO support. ECMO survivors with a history of pre-ECMO RRT were excluded. A total of 5,898 ECMO survivors were included in the analysis. At the 1-year post-ECMO follow-up, 447 patients (7.6%) were newly diagnosed with ESRD requiring RRT. Preexisting renal disease (odds ratio [OR]: 2.83), increased duration of continuous RRT during hospitalization (OR: 1.16), the cardiovascular group (vs. respiratory group; OR: 1.78), and the postcardiac arrest group (vs. respiratory group; OR: 2.52) were associated with newly diagnosed ESRD. Moreover, patients with newly diagnosed ESRD were associated with a 1.56-fold higher risk of 3-year all-cause mortality than those in the control group (hazard ratio: 1.56). At the 1-year post-ECMO follow-up, 7.6% of ECMO survivors were newly diagnosed with ESRD requiring RRT. Moreover, post-ECMO ESRD was associated with poorer long-term survival among ECMO survivors.
Identification of key genes and microRNAs for multiple sclerosis using bioinformatics analysis
Authors: Xu Zhong-bo , Feng Xin , Zhu Wei-na , Qiu Ming-liang
Published: December 2021

To better understand the molecular mechanism underlying the pathogenesis of multiple sclerosis (MS), we aimed to identify the key genes and microRNAs (miRNA) associated with MS and analyze their interactions. Differentially expressed genes (DEGs) and miRNAs (DEMs) based on the gene miRNA dataset GSE17846 and mRNA dataset GSE21942 were determined using R software. Next, we performed functional enrichment analysis and constructed a protein–protein interaction network. Data validation was performed to ensure the reliability of hub genes. The miRNA-mRNA regulatory network was constructed. In total, 47 DEMs and 843 DEGs were identified. Protein–protein interaction network analysis identified several hub genes, including JUN, FPR2, AKT1, POLR2L, LYZ, CXCL8, HBB, CST3, CTSZ, and MMP9, especially LYZ and CXCL8. We constructed an miRNA-mRNA regulatory network and found that hsa-miR-142-3p, hsa-miR-107, hsa-miR-140-5p, and hsa-miR-613 were the most important miRNAs. This study reveals some key genes and miRNAs that may be involved in the pathogenesis of MS, providing potential targets for the diagnosis and treatment of MS.
Prognostic indicators for the onset of ischaemic versus haemorrhagic stroke in stable coronary artery disease
Authors: Wang Wei-Ting , Wu Tao-Cheng , Tseng Wei-Kung , Wu Yen-Wen , Lin Tsung-Hsien , Yeh Hung-I , Chang Kuan-Cheng , Wang Ji-Hung , Leu Hsin-Bang , Yin Wei-Hsian , Wu Chau-Chung , Chen Jaw-Wen
Published: December 2021

The incidence of stroke may be increased in patients with coronary artery disease (CAD). We aimed to investigate the specific risk factors for the development of ischaemic and haemorrhagic stroke in stable CAD patients.

Patients with stable CAD were prospectively enrolled for future cardiovascular events in Taiwan. All the patients had received coronary interventions and were stable for least 1 month before enrolment. The incidence of ischaemic stroke was identified and confirmed by telephone and hospital records. Baseline characteristics, including demographic data, lipid profiles, medications, and biomarkers for potential inflammatory and atherosclerosis, were analysed.

In total, 1428 patients (age, 63.07 ± 11.4 years; 1207 males) were under standard medical treatment and regularly followed-up for at least 4 years. Multivariate logistic regression analysis showed that baseline serum myeloperoxidase (MPO) level (hazard ratio [HR]: 1.89, 95% CI: 1.16–3.10, P = .01) and statin use (HR: 0.37; 95% CI: 0.17–0.79, P = .01) were independently associated with the onset of ischaemic stroke. Age (HR: 1.07, 95% CI: 1.00–1.14, P = .04) and angiotensin receptor blocker (ARB) use (HR: 0.37, 95% CI: 0.17–0.79, P = .01) were independently associated with future onset of intracranial haemorrhage (ICH), implying the different mechanisms of ischaemic stroke and ICH.

Age and ARB use were related to ICH onset. Baseline MPO level and statin use were independently associated with longer and shorter future ischaemic stroke onset in stable CAD patients, respectively. Further studies are indicated to confirm the potential mechanisms and advance individual risk stratification for the onset of different types of stroke in clinical CAD.
Prediction of anemia on enhanced computed tomography of the thorax using virtual non-contrast reconstructions
Authors: Iuga Andra-Iza , Pennig Lenhard , Caldeira Liliana Lourenco , Maintz David , Hickethier Tilman , Doerner Jonas
Published: December 2021

To determine if anemia can be predicted on enhanced computed tomography (CT) examinations of the thorax using virtual non-contrast (VNC) images, in order to support clinicians especially in diagnosing primary asymptomatic patients in daily routine.

In this monocentric study, 100 consecutive patients (50 with proven anemia), who underwent a contrast-enhanced CT examination of the thorax due to various indications were included. Attenuation was measured in the descending thoracic aorta, the intraventricular septum, and the left ventricle cavity both in the conventional contrast-enhanced and in the VNC images.

Two experienced radiologists annotated the delineation of a dense interventricular septum or a hyperattenuating aortic wall sign for all patients.

Hemoglobin levels were then correlated with the measured attenuation values, as well as the visualization of the aortic wall or interventricular septum.

Good correlation was shown between hemoglobin levels and CT attenuation values of the left ventricular cavity (r = .59), aorta (r = .56), and ratio between left ventricular cavity and the intraventricular septum (r = .57). Receiver operating characteristic curve revealed ≤ 36.5 hounsfield units (left ventricular cavity) as the threshold for diagnosing anemia. Predicting anemia by visualization of a hyperattenuating aortic wall or a dense interventricular septum yielded a specificity of 98% and 92%, respectively.

Predicting anemia on enhanced CT examinations using VNC is feasible. A threshold value of ≤ 36.5 hounsfield units (left ventricular cavity) best defines anemia. Aortic wall or interventricular septum visualization on VNC is a specific anemia indicator.
Ataxia due to injury of the cortico-ponto-cerebellar tract in patients with mild traumatic brain injury
Authors: Jang Sung Ho , Lee Han Do
Published: December 2021

Introduction:

The cortico-ponto-cerebellar tract (CPCT) is involved in coordination of movement; injury of the CPCT can therefore be accompanied by ataxia. In this study, using diffusion tensor tractography (DTT), we investigated injury of the CPCT in patients with mild traumatic brain injury (TBI).

Methods:

We recruited 45 consecutive patients with ataxia following mild TBI and 20 normal control subjects. The score of assessment and rating of ataxia (SARA) was used to evaluate of ataxia. The patients were classified into 2 groups based on the SARA; patient group A had with post-traumatic ataxia and patient group B had without post-traumatic ataxia. The fractional anisotropy (FA) value and fiber number (FN) of the CPCT was measured.

Results:

Significant differences were observed in the FA and FN values of the CPCT between patient group A and the control group and between patient groups A and B (P < .05). In addition, a significant difference was observed in the FA value only of the CPCT between patient group B and the control group (P < .05). However, no significant difference was observed in the FN value of the CPCT between patient group B and the control group (P > .05).

Conclusion:

By using DTT, injury of the CPCT was demonstrated in patients who showed ataxia following mild TBI. These results suggest that DTT would be useful for evaluation of the CPCT in patients with ataxia after mTBI because mTBI usually does not show any abnormalities on conventional brain MRI.
Risk factors of postoperative complications following total knee arthroplasty in Korea
Authors: Ko Min-Seok , Choi Chong-Hyuk , Yoon Han-Kook , Yoo Ju-Hyung , Oh Hyun-Cheol , Lee Jin-Ho , Park Sang-Hoon
Published: December 2021

Background:

The number of patients undergoing total knee arthroplasty (TKA) is gradually increasing and there is also increase in postoperative complications. The patient's demographic, socio-economic factors, hospital and clinical factors are all factors that can influence postoperative complications. The purpose of this study was to determine the risk factors associated with complications following TKA in a large national cohort.

Methods:

Among patients diagnosed with primary knee arthrosis, a total of 560,954 patients older than 50 years who underwent TKA from January 1, 2005 to December 31, 2018 were included in the study. The risk of postoperative complications (surgical site infection, sepsis, cardiovascular complications, respiratory complications, pulmonary embolism, stroke, acute renal failure, periprosthetic joint infection, and periprosthetic fracture) were assessed with eight independent variables: gender, age, place of residence, household income, hospital bed size, procedure type (unilateral or bilateral, primary or revision TKA), length of stay (LOS), use of transfusion. Multivariable Cox Proportional Hazard model analysis was used. The significant predictors for complications (P < .05) were as follows.

Results:

Surgical site infection: male, procedure type (bilateral, revision), LOS (≥35 days), transfusion. Sepsis: male, household income, procedure type (bilateral, revision), LOS (≥35 days), transfusion. Cardiovascular complications: male, age, household income, procedure type (bilateral, revision), LOS (≥35 days), transfusion. Respiratory complications: male, household income, procedure type (bilateral, revision), LOS (≥35 days), transfusion. Pulmonary embolism: male, household income, procedure type (bilateral, revision), LOS (≥35 days), transfusion. Stroke: male, age, procedure type (bilateral, revision), LOS (≥35 days), transfusion. Acute renal failure: male, household income, procedure type (bilateral, revision), LOS (≥35 days), transfusion. Periprosthetic joint infection: male, household income, procedure type (bilateral, revision), LOS (≥35 days), transfusion. Periprosthetic fracture: male, procedure type (bilateral, revision), LOS (≥35 days), transfusion.

Conclusion:

In summary, male, procedure type (bilateral, revision), LOS (≥35 days), and use of transfusion were shown to be risk factors of postoperative complications following TKA.
A cross-sectional follow up study to estimate seroprevalence of coronavirus disease 2019 in Kobe, Japan
Authors: Doi Asako , Iwata Kentaro , Kuroda Hirokazu , Hasuike Toshikazu , Nasu Seiko , Nishioka Hiroaki , Tomii Keisuke , Morimoto Takeshi , Kihara Yasuki
Published: December 2021

We conducted a study to estimate the seroprevalence of coronavirus disease 2019 (COVID-19) in Kobe, Japan with positive immunoglobulin G (IgG) rate of 3.3% (95% confidence interval [CI] 2.3%–4.6%) in April 2020. Because there were large concerns about the spread of COVID-19 among citizens thereafter, we conduct a follow-up cross-sectional study to estimate the seroprevalence, and we also added a validation study using a different assay.

We conducted cross-sectional serologic testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody using 1000 samples from patients at outpatient settings who visited the clinic from May 26 to June 7, 2020, stratified by the decade of age and sex. We used both Kurabo and Abbott serology assays to identify IgG against SARS-CoV-2.

There were 18 and 2 positive IgG among 1000 serum samples using Kurabo and Abbott serology assays, respectively (1.8%, 95% CI 1.1%–2.8%, and 0.2%, 95% CI 0.02%–0.7% respectively). By applying the latter figure to the census of Kobe City (population: 1,518,870), it is estimated that the number of people with positive IgG is 3038 (95% CI: 304–10,632) while a total of 285 patients were identified by polymerase chain reaction (PCR) testing at the end of the study period. Assuming Abbott assay as the reference, Kurabo assay had calculated sensitivity and specificity of 100% and 98.4% respectively. Age and sex adjusted prevalence of positivity was calculated to be 0.17%.

We found a lower seroprevalence than 2 months before in Kobe city although the figures were still higher than those detected by PCR. Kurabo assay showed more false positives than true positives despite reasonable sensitivity and specificity, due to low prevalence in Kobe.
Relapsed/refractory acute promyelocytic leukemia with RARA-LBD region mutation was salvaged by venetoclax
Authors: Li Youli , Yu Jieni , Xu Qinhong , Zhang Kejie
Published: December 2021

Rationale:

Acute promyelocytic leukemia (APL) is one of the most curable cancers. However, relapse of the disease is a difficult issue in clinical practice and it remains a great challenge that patients have a poor effect of conventional treatment in the clinic. Therefore, new and more effective therapeutic measures are urgently needed. Herein, we report a case of relapsed and refractory APL harboring a RARA-LBD region mutation successfully treated with venetoclax (VEN).

Patient concerns:

A 37-years-old woman was admitted to our hospital with worsening spontaneous gingival bleeding and skin ecchymosis. Physical examination revealed multiple petechiae and ecchymosis in the extremities.

Diagnoses:

The patient was diagnosed with L-type PML-RARα-positive APL, harboring a RARA-LBD region mutation, low-risk, based on bone marrow cytology, immunophenotypic analysis by flow cytometry, karyotype analysis, and molecular analysis.

Interventions:

Complete remission was achieved after the first induction therapy of all-trans retinoic acid (ATRA) combined with arsenic trioxide, but relapse was observed only after 11 months. Reinduction with ATRA and arsenic trioxide combined with anthracycline failed. Therefore, we tried to provide a new treatment with the Bcl-2 inhibitor VEN orally (100 mg d1, 200 mg d2 to d18, followed by 300 mg daily continuously).

Outcomes:

Clinical symptoms and laboratory indicators improved rapidly with VEN treatment. A complete hematologic response was achieved with VEN-based therapy.

Lessons:

Related drug resistance gene monitoring should be performed canonically in relapsed and refractory APL. Some relapsed and refractory APL that failed to respond to conventional treatment were at risk of death. Bcl-2 inhibitors are expected to be an effective salvage therapy for patients with resistance to ATRA, which is worthy of further discussion.
Predictors of Covid-19 vaccination acceptance in IBD patients: a prospective study
Authors: Viola Anna , Muscianisi Marco , Li Voti Raffaele , Costantino Giuseppe , Alibrandi Angela , Fries Walter
Published: December 2021

Background

Adherence to vaccinations is unsatisfactory in the inflammatory diseases (IBD) population because of concerns regarding adverse events or low perception of infectious risk. The aim of this study was to maximise adherence to anti-Covid-19 vaccination in IBD patients.

Methods

In the third trimester of 2020, all IBD patients were informed concerning the need for anti-Covid-19 vaccination and family physicians were advised to proceed with anti-Influenza and anti-pneumococcus vaccinations. Demographic data, disease-related data together with acceptance of vaccinations were recorded. From May 2021, vaccinations of IBD patients were directly arranged at our hospital. We registered performance, procrastination or denial of anti-Covid-19 vaccination, type of vaccine and adverse events.

Results

Five hundred and twenty-three patients were included (Crohn’s: 266, ulcerative colitis: 257; M/F 289/234; mean age 48 ± 17 years); 53 patients were excluded from analysis as they became infected with SARS-CoV-2 during the study period; overall adherence to vaccination was 400/470 (85%), procrastinators 44 (9%) and 27 patients (6%) refused. Compared with influenza (58%) and pneumococcus (65%) vaccinations, acceptance was higher for anti-Covid-19 vaccination (P < 0.0001, both). Mild adverse events occurred in 31% and two (0.5%) needed precautionary but uneventful hospitalization. On multiple stepwise regression analysis, factors positively associated with adherence to vaccination were age (P < 0.039; OR, 1.016, 95% CI: 1.001–1.031) and previous anti-influenza vaccination (P < 0.008; OR, 2.071, 95% CI: 1.210–3.545).

Conclusions

Direct counselling and on-site administration were associated with a satisfactory acceptance of anti-Covid-19 vaccination, whereas vaccinations against influenza and pneumococcus remained below expected levels. Increased risk perception may account for the observed differences.
ANGPTL4: a new mode in the regulation of intravascular lipolysis
Authors: Ploug Michael
Published: December 2021

Purpose of review

Lipoprotein lipase (LPL) is the rate-limiting enzyme for intravascular processing of circulating triglyceride-rich lipoproteins (TRLs). One emerging strategy for therapeutic lowering of plasma triglyceride levels aims at increasing the longevity of LPL activity by attenuating its inhibition from angiopoietin-like proteins (ANGPTL) 3, 4 and 8. This mini-review focuses on recent insights into the molecular mechanisms underpinning the regulation of LPL activity in the intravascular unit by ANGPTLs with special emphasis on ANGPTL4.

Recent findings

Our knowledge on the molecular interplays between LPL, its endothelial transporter GPIHBP1, and its inhibitor(s) ANGPTL4, ANGPTL3 and ANGPTL8 have advanced considerably in the last 2 years and provides an outlined on how these proteins regulate the activity and compartmentalization of LPL. A decisive determinant instigating this control is the inherent protein instability of LPL at normal body temperature, a property that is reciprocally impacted by the binding of GPIHBP1 and ANGPTLs. Additional layers in this complex LPL regulation is provided by the different modulation of ANGPTL4 and ANGPTL3 activities by ANGPTL8 and the inhibition of ANGPTL3/8 complexes by apolipoprotein A5 (APOA5).

Posttranslational regulation of LPL activity in the intravascular space is essential for the differential partitioning of TRLs across tissues and their lipolytic processing in response to nutritional cues.
Frequency, Predisposing Factors, and Clinical Outcome of Azathioprine-Induced Pancreatitis Among Patients With Inflammatory Bowel Disease
Authors: Eskazan Tugce , Bozcan Selma , Atay Kadri , Yildirim Suleyman , Demir Nurhan , Celik Sinem , Tuncer Murat , Hatemi Ibrahim , Celik Aykut Ferhat , Erzin Yusuf
Published: December 2021

Objective

The aim of the study was to identify the frequency of azathioprine-induced acute pancreatitis (AZA-AP) and related factors.

Methods

Seven hundred eighty-seven inflammatory bowel disease (IBD) patients on AZA therapy were retrospectively analyzed. Azathioprine-induced AP was diagnosed with positive imaging and/or an at least 3-fold increased amylase level, in presence of typical abdominal pain. The AZA-AP group was compared with patients on AZA therapy with no history of pancreatitis and 4 numerical adjacent cases with the same diagnosis were selected (group B).

Results

Fifty-four patients developed gastrointestinal symptoms (6.9%); however, only half of them (26 of 54) had pancreatitis, except 1, all within the first 2 months under AZA. When the AZA-AP group was compared with group B, only budesonide usage and active smoking were significantly more common in group A (46.2% vs 25%, P = 0.034, and 77% vs 51%, P = 0.017, respectively). Active smoking was the only independent risk factor for AZA-AP development (odds ratio, 3.208 [95% confidence interval, 1.192–8.632]).

Conclusions

All IBD patients developed AZA-AP nearly all within the first 2 months. Azathioprine intolerance may be a hidden diagnosis in at least half of the patients with AZA-AP symptoms. All smoker IBD patients should be monitored closely for AZA-AP development.
Prevalence, Incidence, and Risk of Progression of Asymptomatic Pancreatic Cysts in Large Sample Real-world Data
Authors: Schweber Adam B. , Agarunov Emil , Brooks Christian , Hur Chin , Gonda Tamas A.
Published: December 2021

Objectives

Using large-sample, real-world administrative claims data, we evaluated the prevalence of putatively asymptomatic pancreatic cysts, the historical growth in their incident diagnosis, and their risk of malignant progression.

Methods

Data were sourced from IBM MarketScan administrative claims databases of more than 200 million patients. Period prevalence was assessed using 700,000 individuals without conditions that predispose to pancreatic cyst. The standardized cumulative incidence was compared with the cross-sectional abdominal imaging rate from 2010–2017. The risk of progression to pancreatic cancer for 14,279 newly diagnosed patients with a cyst was estimated using Kaplan-Meier analysis.

Results

Standardized prevalence increased exponentially with age and was 1.84% (95% confidence interval, 1.80%–1.87%) for patients older than 45. Standardized incidence nearly doubled from 2010–2017 (6.3 to 11.4 per 10,000), whereas the imaging rate changed from only 8.0% to 9.4%. The cumulative risk of pancreatic cancer at 7 years was 3.0% (95% confidence interval, 2.4%–3.5%), increasing linearly (R
2 = 0.991) with an annual progression risk of 0.47%.

Conclusions

Using large-sample data, we show a significant burden of asymptomatic pancreatic cysts, with an annual risk of progression to cancer of 0.47% for 7 years. Rapid growth in cyst diagnosis over the last decade far outpaced increases in the imaging rate.
Methylation-based Cell-free DNA Signature for Early Detection of Pancreatic Cancer
Authors: Ying Lee , Sharma Anup , Chhoda Ankit , Ruzgar Nensi , Hasan Nesrin , Kwak Ruby , Wolfgang Christopher L. , Wang Tza Huei , Kunstman John W. , Salem Ronald R. , Wood Laura D. , Iacobuzio-Donahue Christine , Schneider Eric B. , Farrell James J. , Ahuja Nita
Published: December 2021

Objectives

The potential of DNA methylation alterations in early pancreatic cancer (PC) detection among pancreatic tissue cell-free DNA seems promising. This study investigates the diagnostic capacity of the 4-gene methylation biomarker panel, which included ADAMTS1, BNC1, LRFN5, and PXDN genes, in a case-control study.

Methods

A genome-wide pharmacoepigenetic approach identified ADAMTS1, BNC1, LRFN5, and PXDN genes as putative targets. Tissue samples including stage I–IV PC (n = 44), pancreatic intraepithelial neoplasia (n = 15), intraductal papillary mucinous neoplasms (n = 24), and normal pancreas (n = 8), and cell-free DNA, which was acquired through methylation on beads technology from PC (n = 22) and control patients (n = 10), were included. The 2−∆ct was the outcome of interest and underwent receiver operating characteristic analysis to determine the diagnostic accuracy of the panel.

Results

Receiver operating characteristic analysis revealed an area under the curve of 0.93 among ADAMTS1, 0.76 among BNC1, 0.75 among PXDN, and 0.69 among LRFN5 gene. The combination gene methylation panel (ADAMTS1, BNC1, LRFN5, and PXDN) had an area under the curve of 0.94, with a sensitivity of 100% and specificity of 90%.

Conclusions

This methylation-based biomarker panel had promising accuracy for PC detection and warranted further validation in prospective PC surveillance trials.
Borderline Resectable and Locally Advanced Pancreatic Cancers
Authors: Khachfe Hussein H. , Habib Joseph R. , Nassour Ibrahim , Al Harthi Salem , Jamali Faek R.
Published: December 2021

Locally advanced and borderline resectable pancreatic cancers are being increasingly recognized as a result of significant improvements in imaging modalities. The main tools used in diagnosis of these tumors include endoscopic ultrasound, computed tomography, magnetic resonance imaging, and diagnostic laparoscopy. The definition of what constitutes a locally advanced or borderline resectable tumor is still controversial to this day. Borderline resectable tumors have been treated with neoadjuvant therapy approaches that aim at reducing tumor size, thus improving the chances of an R0 resection. Both chemotherapy and radiotherapy (solo or in combination) have been used in this setting. The main chemotherapy agents that have shown to increase resectability and survival are FOLFORINOX (a combination of folinic acid, fluorouracil, irinotecan, and oxaliplatin) and gemcitabine–nab-paclitaxel. Surgery on these tumors remains a significantly challenging task for pancreatic surgeons. More studies are needed to determine the best agents to be used in the neoadjuvant and adjuvant settings, biologic markers for prognostic and operative predictions, and validation of previously published retrospective results.
Transient End‐Tidal Carbon Dioxide Elevation During Pediatric Upper Endoscopy With Carbon Dioxide Insufflation
Authors: Dike Chinenye R. , Bishop Warren P. , Titler Sarah S. , Rahhal Riad
Published: December 2021

Background:

Endoscopic insufflation, long performed using air, is being replaced by carbon dioxide (CO2) at many pediatric centers, despite limited published data on its use in children. We have previously demonstrated that CO2 use during esophagogastroduodenoscopy (EGD) in non‐intubated children is associated with transient elevations of end‐tidal CO2 (EtCO2). This observation raised concerns about possible CO2 inhalation and systemic absorption. Here, we investigate this concern by concurrently measuring both EtCO2 and transcutaneous CO2 (tCO2) during upper endoscopic procedures in children.

Aim:

To determine if elevations in EtCO2 levels seen in non‐intubated children undergoing CO2 insufflation during EGD are associated with elevated systemic CO2 levels.

Methods:

Double‐blinded, prospective, randomized clinical trial. Children were randomized 1:1 to receive either CO2 or air for endoscopic insufflation. EtCO2 was sampled with a CO2‐sampling nasal cannula and tCO2 was monitored using the Radiometer transcutaneous monitoring device.

Results:

Fifty nine patients were enrolled; 30 patients in the CO2 insufflation group and 29 in the air group. All patients underwent a procedure involving an EGD. Transient elevations in EtCO2 (defined as >60 mmHg) were observed only in the CO2 insufflation group. This contrasted with the similar elevations of tCO2 between the CO2 and air insufflation groups. None of these events were of clinically significant magnitude or duration.

Conclusion:

This study demonstrates that the observed transient elevations in EtCO2 seen during EGD in non‐intubated children receiving CO2 insufflation are most likely measurements of eructated CO2 without evidence of excessive systemic absorption of CO2.
The Alter Program
Authors: Epps Fayron , Moore Miranda , Chester Mia , Gore Janelle , Sainz Mayra , Adkins Aisha , Clevenger Carolyn , Aycock Dawn
Published: December 2021

Dementia is a stigmatizing condition requiring enhanced awareness and understanding. Churches are a trusted source of support for African Americans, a demographic disproportionately affected by dementia. However, many African American churches are not equipped with the knowledge and means to provide safe environments, resources, and spiritual and social support for their parishioners living with dementia and their families. This protocol is written to detail the design and implementation of a nurse-led, dementia-friendly congregation program, Alter. The Alter program was developed to increase dementia awareness, develop a supportive, faith-based dementia-friendly infrastructure, and create a community supporting the well-being of African Americans living with dementia and their families. Engagement in this program aims to improve brain health status of older adults, improve physical and mental health outcomes, reduce dementia stigma, and enhance personal agency. Improved outcomes for persons living with dementia translate into lower use of acute and emergency services due to more stability in community care. It is expected that the churches participating in this program will be recognized by their community as a great resource for dementia information and support. The long-term goal of the Alter program is to be widely adapted in various health systems to reduce health disparities associated with dementia in the African American community.
A Health Care System's Approach to Support Nursing Leaders in Mitigating Burnout Amid a COVID-19 World Pandemic
Authors: Trepanier Sylvain , Henderson Robin , Waghray Arpan
Published: December 2021

Burnout has been demonstrating its presence in the nursing profession for decades. The advent of the world pandemic exacerbated the impact of burnout, and health care workers are suffering. In this article, the authors offer a review of burnout and its effect on the nursing profession. The authors describe a health care system's response to support its 48000 nurses. On the basis of critical drivers that influence the state of engagement of any nurses, we implemented a program allowing us to proactively partner with core leaders to support the emotional well-being of their caregivers. We provide focused coaching and support to leaders and their teams experiencing the highest stress levels. Finally, this article offers concrete interventions that nurse leaders should consider to support their respective nurses.
Unmet Birth Expectations and Birth Trauma among Adolescents
Authors: Anderson Cheryl A. , Akinmade Faith
Published: December 2021

Purpose:

To assess and compare birth expectations of younger and older age adolescents and explore if unmet expectations predict psychological birth trauma (PBT).

Study Design and Methods:

This secondary analysis expands findings of a previous study (N = 303) which classified adolescents' perceptions of birth into four main themes. The previous study used a mixed-methods approach providing data related to birth expectations. For the current study, expectations were determined by themes as met or unmet by three reviewers. Of 116 useable written narrations, responses of younger (ages 13-17) versus older (ages 18-19) adolescents were compared and explored for impact on PBT.

Results:

Birth expectations for both age groups were more often unmet than met. Despite a smaller cohort, younger adolescents provided more remarks than older adolescents. There were no differences between groups on unmet birth expectations (p = .16). Unmet expectations most often related to pain with older adolescents more inclined to state poor pain management. Younger adolescents more often feared dying. Unmet expectations did not predict PBT.

Clinical Implications:

Comprehensive prenatal care can allow for early, open conversations to assess labor knowledge and misconceptions, fear of birth, existing supports, and overall birth expectations, with a premier focus on expected labor pain and pain management. Multiparous adolescents should receive prenatal assessments of posttraumatic stress (PTS) symptoms (a recognized predictor of posttraumatic stress syndrome) potentially originating from a previous traumatic birth. Following birth, symptoms of acute stress and PTS should be assessed of all adolescents, especially if experienced numerous unmet labor expectations.
Mechanical testing of cephalomedullary nail lag screws after the addition of hydroxyapatite substitutes
Authors: Nakajima Takayuki , Aoki Yasuchika , Watanabe Atsuya , Inoue Masahiro , Yamaguchi Satoshi , Nakamura Junichi , Matsuura Yusuke , Hagiwara Shigeo , Himeno Daisuke , Ohtori Seiji
Published: December 2021

Objective:

To compare the effects of 3 implant designs, with and without hydroxyapatite reinforcement, on push/pull-out strength and rotational torque.

Methods:

Three implant designs (Gamma 3, INTERTAN, and PFNA-II) were selected for comparison. A hydroxyapatite cylinder (NEOBRACE) was used to reinforce the interface between the femoral head and the lag screw. Maximum push-out strength, maximum pull-out strength, and peak rotational torque were measured in cellular blocks mimicking osteoporotic cancellous bone, with and without NEOBRACE.

Results:

In the push-out test, INTERTAN produced a significantly higher push-out strength in osteoporotic bone density cellular blocks than the other lag screws and blades (P < .05). With the addition of NEOBRACE, push-out strength was significantly higher for INTERTAN and PFNA-II (P < .05) than for the non-NEOBRACE group. In the pull-out test, INTERTAN produced a significantly higher pull-out strength in the osteoporotic bone density cellular blocks than did the other lag screws and blades (P < .05). With the addition of NEOBRACE, the pull-out strengths of INTERTAN and Gamma 3 versus those of the non-NEOBRACE group significantly increased (P < .05). In the rotational torque test, INTERTAN produced significantly greater rotational torque in the osteoporotic cellular blocks than the other lag screws and blades (P < .05). The addition of NEOBRACE resulted in a significant increase in rotational torque only for INTERTAN (P < .05).

Conclusion:

The use of NEOBRACE supported an increase in push/pull-out strength and rotational torque, especially in systems with a relatively increased bone or implant interface area.

Level of Evidence: Level V
Hemolysis in Early Infancy
Authors: Wu Hao , Tugal Oya , Perez-Atayde Antonio R.
Published: December 2021

Before the prophylactic use of anti-D antibodies in pregnancy, hemolytic anemia of the newborn was the most common cause of hyperbilirubinemia. Nowadays, given the rarity of hemolytic anemia of the newborn, hepatobiliary abnormalities, perinatal infections, and metabolic disorders have become the most common conditions in the differential diagnosis of neonatal cholestasis. Here, we report 3 instances of cholestatic giant cell hepatitis in 3 infants who had Coombs’ positive hemolysis due to ABO incompatibility in 1, Rh incompatibility in another, and combined ABO and Rh incompatibility in the third. Although rare, cholestatic neonatal giant cell hepatitis associated with hemolysis still needs to be considered in patients with neonatal cholestasis. A marked elevation of aspartate aminotransferase over alanine aminotransferase can be a helpful clue to an early diagnosis.