bluuebunny/crossref_metadata_2025 huggingface dataset:
An Ecological Account of Clinical Reasoning
Authors: Watsjold Bjorn K. , Ilgen Jonathan S. , Regehr Glenn
Published: August 2022

Purpose

The prevailing paradigms of clinical reasoning conceptualize context either as noise that masks, or as external factors that influence, the internal cognitive processes involved in reasoning. The authors reimagined clinical reasoning through the lens of ecological psychology to enable new ways of understanding context-specific manifestations of clinical performance and expertise, and the bidirectional ways in which individuals and their environments interact.

Method

The authors performed a critical review of foundational and current literature from the field of ecological psychology to explore the concepts of clinical reasoning and context as presented in the health professions education literature.

Results

Ecological psychology offers several concepts to explore the relationship between an individual and their context, including affordance, effectivity, environment, and niche. Clinical reasoning may be framed as an emergent phenomenon of the interactions between a clinician’s effectivities and the affordances in the clinical environment. Practice niches are the outcomes of historical efforts to optimize practice and are both specialty-specific and geographically diverse.

Conclusions

In this framework, context specificity may be understood as fundamental to clinical reasoning. This changes the authors’ understanding of expertise, expert decision making, and definition of clinical error, as they depend on both the expert’s actions and the context in which they acted. Training models incorporating effectivities and affordances might allow for antiableist formulations of competence that apply learners’ abilities to solving problems in context. This could offer both new means of training and improve access to training for learners of varying abilities. Rural training programs and distance education can leverage technology to provide comparable experience to remote audiences but may benefit from additional efforts to integrate learners into local practice niches.
A Critical Review of Professional Identity Formation Interventions in Medical Education
Authors: Mount George R. , Kahlke Renate , Melton John , Varpio Lara
Published: August 2022

Purpose

Professional identity formation (PIF) can be defined as the integration of the knowledge, skills, values, and behaviors of a profession with one’s preexisting identity and values. Several different, and sometimes conflicting, conceptualizations and theories about PIF populate the literature; applying these different theories in PIF curricula and pedagogic strategies can profoundly impact the PIF of future physicians. The authors conducted a critical review of the recent literature on PIF interventions in medical education to explore the conceptualizations of and theoretical approaches to PIF that underlie them.

Method

The authors searched articles on PIF educational interventions published in 5 major medical education journals between 2010 and March 2021. The articles’ context and findings were extracted, analyzed, and summarized to identify conceptualizations and theoretical approaches to PIF.

Results

The authors identified 43 studies examining medical education interventions aimed at influencing PIF. The majority of the studies (n = 31) focused on undergraduate medical education. Reflective writing and the use of narrative reflections were the dominant modes of student activity in PIF interventions, supporting the dominant individualist approach to PIF. Less commonly PIF was understood as a socialization process or as an active process with both individually and socially focused influences.

Conclusions

Relying on reflective writing as the intervention of choice to impact PIF feeds the dominant individualist perspective on PIF. An unintended consequence of this individualist orientation is that cultural problems embedded in the profession can become burdens for individual physicians to personally bear. Future education and research into PIF should account for theoretical preferences and the impact of these preferences.
Can We Realize Our Collaborative Potential? A Critical Review of Faculty Roles and Experiences in Interprofessional Education
Authors: Cimino Francesca M. , Varpio Lara , W. Konopasky Abigail , Barker Andrea , Stalmeijer Renée E. , Ma Ting-Lan
Published: August 2022

Purpose

Faculty within interprofessional education (IPE) are essential contributors to IPE implementation efforts. Although the majority of existing IPE literature consists of reports on IPE innovations, few insights are available into the experiences of the faculty members who deliver IPE. This critical narrative review was designed to synthesize the knowledge available about (1) roles assigned to IPE educators and (2) IPE faculty members’ experiences of fulfilling these roles.

Method

Six databases for English-language studies published between 2000 and March 2021 were searched: PubMed, Embase, Web of Science, MEDLINE, CINAHL, PsycINFO, ERIC, and MedEdPortal. A total of 1,717 manuscripts were identified for possible inclusion. After applying inclusion/exclusion criteria, 214 articles constituted the final literature corpus. Harden and Crosby’s original framework of 6 roles of medical educators augmented with the manager role introduced in Harden and Lilley’s 2018 framework informed the analysis.

Results

IPE faculty take on all 6 roles identified by Harden and Crosby: facilitator, planner, information provider, examiner, role model, and resource developer, as well as the manager role. Faculty were most commonly identified as facilitator and planner, and rarely as role models. The authors identified 3 main struggles experienced by IPE faculty: personal (e.g., confidence as a cross-professions educator), interpersonal (e.g., co-teaching IPE), and institutional (e.g., supporting IPE logistics).

Conclusions

This review highlights the complexity of the roles taken on by IPE faculty and the struggles they experience in the process. The results suggest that attention to the different roles that IPE faculty play in educational interventions and to equipping faculty with the necessary competencies, tools, and support, is fundamental to the success of IPE. Future research should harness the explanatory power of theories to help explain dynamics at play between personal, interpersonal, and institutional barriers to identify interventions that can aid IPE faculty in delivering collaboration-ready professionals.
Rates of Postoperative Complications and Approach-related Neurological Symptoms After L4–L5 Lateral Transpsoas Lumbar Interbody Fusion Compared With Upper Lumbar Levels
Authors: Nolte Michael T. , Gandhi Sapan D. , Nguyen Austin Q. , Siyaji Zakariah K. , Piracha Ali Z. , Khanna Krishn , Rush Augustus J. , Sheha Evan D. , Phillips Frank M.
Published: August 2022

Study Design:

This was a retrospective comparative study.

Objective:

To compare the likelihood of approach-related complications for patients undergoing single-level lateral lumbar interbody fusion (LLIF) at L4–L5 to those undergoing the procedure at upper lumbar levels.

Summary of Background Data:

LLIF has been associated with a number of advantages when compared with traditional interbody fusion techniques. However, potential risks with the approach include vascular or visceral injury, thigh dysesthesias, and lumbar plexus injury. There are concerns of a higher risk of these complications at the L4–L5 level compared with upper lumbar levels.

Materials and Methods:

A retrospective cohort review was completed for consecutive patients undergoing single-level LLIF between 2004 and 2019 by a single surgeon. Indication for surgery was symptomatic degenerative lumbar stenosis and/or spondylolisthesis. Patients were divided into 2 cohorts: LLIF at L4–L5 versus a single level between L1 and L4. Baseline characteristics, intraoperative complications, postoperative approach-related neurological symptoms, and patient-reported outcomes were compared and analyzed between the cohorts.

Results:

A total of 122 were included in analysis, of which 58 underwent LLIF at L4–L5 and 64 underwent LLIF between L1 and L4. There were no visceral or vascular injuries or lumbar plexus injuries in either cohort. There was no significant difference in the rate of postoperative hip pain, anterior thigh dysesthesias, and/or hip flexor weakness between the cohorts (53.5% L4–L5 vs. 37.5% L1–L4; P=0.102). All patients reported complete resolution of these symptoms by 6-month postoperative follow-up.

Discussion:

LLIF surgery at the L4–L5 level is associated with a similar infrequent likelihood of approach-related complications and postoperative hip pain, thigh dysesthesias, and hip flexor weakness when compared with upper lumbar level LLIF. Careful patient selection, meticulous use of real-time neuromonitoring, and an understanding of the anatomic location of the lumbar plexus to the working corridor are critical to success.
How are Patients Describing You Online? A Natural Language Processing Driven Sentiment Analysis of Online Reviews on CSRS Surgeons
Authors: Tang Justin , Arvind Varun , White Christopher A. , Dominy Calista , Cho Samuel , Kim Jun S.
Published: August 2022

Study Design:

A quantitative analysis of written, online reviews of Cervical Spine Research Society (CSRS) surgeons.

Objective:

This study quantitatively analyzes the written reviews of members of the CSRS to report biases associated with demographic factors and frequently used words in reviews to help aid physician practices.

Summary of Background Data:

Physician review websites have influence on a patient’s selection of a provider, but written reviews are subjective. Sentiment analysis of writing through artificial intelligence can quantify surgeon reviews to provide actionable feedback.

Methods:

Online written and star-rating reviews of CSRS surgeons were obtained from healthgrades.com. A sentiment analysis package was used to obtain compound scores of each physician’s reviews. The relationship between demographic variables and average sentiment score of written reviews were evaluated through t-tests. Positive and negative word and bigram frequency analysis was performed to indicate trends in the reviews’ language.

Results:

In all, 2239 CSRS surgeon’s reviews were analyzed. Analysis showed a positive correlation between the sentiment scores and overall average star-rated reviews (r
2=0.60, P<0.01). There was no difference in review sentiment by provider sex. However, the age of surgeons showed a significant difference as those <55 had more positive reviews (mean=+0.50) than surgeons >=55 (mean=+0.37) (P<0.01). The most positive reviews focused both on pain and behavioral factors, whereas the most negative focused mainly on pain. Behavioral attributes increased the odds of receiving positive reviews while pain decreased them.

Conclusion:

The top-rated surgeons were described as considerate providers and effective at managing pain in their most frequently used words and bigrams. However, the worst-rated ones were mainly described as unable to relieve pain. Through quantitative analysis of physician reviews, pain is a clear factor contributing to both positive and negative reviews of surgeons, reinforcing the need for proper pain expectation management.

Level of Evidence:

Level 4—retrospective case-control study.
LncRNA OSTM1-AS1 acts as an oncogenic factor in Wilms’ tumor by regulating the miR-514a-3p/MELK axis
Authors: Du Jun , Xiao Jingjing , Zhuo Yingquan , Nie Meilan , Yang Jiafei , Luo Xi , Gu Huajian
Published: August 2022

Wilms’ tumor (WT) is the most typical basic renal tumor in children and is associated with a high recurrence rate and improper diagnosis. Long noncoding RNAs (lncRNAs) play important roles in WT development. However, the impact of the OSTM1 antisense RNA 1 (OSTM1-AS1) lncRNA on WT remains largely unexplored. Differential expression of OSTM1-AS1, miR-514a-3p and maternal embryonic leucine zipper kinase (MELK) in mice with WT cells was assessed via quantitative reverse transcription-PCR and western blotting. Changes in the proliferation, migration and apoptosis of WT cells after OSTM1-AS1, miR-514a-3p or MELK knockdown were assessed using the cell counting kit-8, Transwell and caspase-3 activity assays, respectively. Additionally, the tumorigenicity of WT cells after OSTM1-AS1 knockdown in vivo was analyzed using a xenograft tumor assay. The association among OSTM1-AS1, MELK and miR-514a-3p was confirmed using the RNA binding protein immunoprecipitation and luciferase reporter assays. OSTM1-AS1 and MELK were upregulated in WT cells, whereas miR-514a-3p was downregulated. OSTM1-AS1 was mostly observed in the cytoplasm, and its knockout suppressed WT cell migration and proliferation in vitro, triggered apoptosis and attenuated tumor development in vivo. MiR-514a-3p was sponged by OSTM1-AS1, and miR-514a-3p interference counteracted the tumoricidal effect of OSTM1-AS1 knockdown. MiR-514a-3p reduced WT progression by downregulating the expression of MELK, which is the target gene of miR-514a-3p. lncRNA OSTM1-AS1 acts as an oncogenic factor in WT by releasing MELK through sponging miR-514a-3p and could be a useful target for WT diagnosis and therapy.
KDM5B regulates the PTEN/PI3K/Akt pathway to increase sorafenib-resistance in hepatocellular carcinoma
Authors: Liu Jia , Nie Chunsheng
Published: August 2022

Lysine-specific demethylase 5B (KDM5B) exerts its tumor-promoting functions in numerous malignancies, although the possible mechanisms by which KDM5B promotes cancer aggressiveness in hepatocellular carcinoma (HCC) have been preliminarily explored, the role of this gene in regulating sorafenib-resistance in HCC has not been studied. Thus, the present study was designed to resolve this problem, and our data suggested that KDM5B was significantly upregulated in the HCC tissues collected from patients with sorafenib treatment history. Consistently, continuous low-dose sorafenib administration increased KDM5B expression levels in the sorafenib-resistant HCC cells compared to their sorafenib-sensitive counterparts. Next, by performing the functional experiments, we found that KDM5B positively regulated sorafenib-resistance and cancer stem cell (CSC) properties in HCC cells in vitro and in vivo. Furthermore, upregulation of KDM5B-degraded phosphatase and tensin homolog (PTEN), results in the activation of the downstream oncogenic PI3K/Akt pathway. Subsequently, the rescuing experiments verified that the promoting effects of KDM5B overexpression on chemoresistance and cancer stemness in HCC cells were all abrogated by PI3K (p110) knockdown and PTEN overexpression. Collectively, those data hinted that KDM5B influenced CSC properties and sorafenib-resistance in HCC cells through modulating the PTEN/PI3K/Akt pathway, and KDM5B could be used as a potential target for the treatment of HCC in clinic.
Unexpected favorable outcome to sintilimab monotherapy in a relapse pancreatic ductal adenocarcinoma patient with high tumor mutational burden: a case report
Authors: Zhang Fan , Li Xiaomin , Liu Haisheng , Liu Rongfeng , Zhou Zhiguo , Zhang Yi , Chen Jingli , Tian Ye , Pan Chaohu , Meng Qingju , Liu Yibing
Published: August 2022

The reason that immune checkpoint inhibitors have not been widely applied to pancreatic cancer treatment is probably because of low immunogenicity or dense stromal fibrosis. Recently, only pembrolizumab was recommended for DNA mismatch repair deficiency or high microsatellite instability by National Comprehensive Cancer Network guideline. Pancreatic ductal adenocarcinoma (PDAC) accounts for more than 90% of pancreatic cancer, with a poor overall survival rate, the value of immunotherapy for PDAC needs more research. Here, we report a 56-year-old man suffered from PDAC with liver metastasis after radical surgery. The next-generation sequencing result demonstrated that it had remarkably high tumor mutational burden (TMB) of 49.92 Muts/Mb and microsatellite stability. Sintilimab (anti-PD-1) monotherapy was continuously administrated after failure of combined chemotherapy in second line, achieving stable disease within 22 months and few immunotherapy-related adverse events. To our knowledge, this is the first time to report a good outcome achieving 22 months with progression-free survival after PDAC metastasis with monotherapy of sintilimab. TMB may serve as a potential efficacy-related predictor in PDAC patients with sintilimab and help physicians make optimum clinical strategy.
Herpesvirus entry mediator regulates the transduction of Tregs via STAT5/Foxp3 signaling pathway in ovarian cancer cells
Authors: Shan Ying , Zhang Beibei , Chen Li , Zhang Hu , Jiang Cui , You Qinghua , Li Yanyi , Han Hongyu , Zhu Jianlong
Published: August 2022

The ratio of regulatory T cells (Treg) in peripheral blood of cancer patients has a closely correlation to the occurrence and development of ovarian cancer. In this study, our aim to explore the expression of herpesvirus entry mediator (HVEM) in ovarian cancer and its correlation with Tregs. The expression of HVEM in peripheral blood of ovarian cancer patients was detected by ELISA, and the ratio of CD4+ CD25 + Foxp3 positive Tregs cells was detected by flow cytometry. Ovarian cancer cell lines with high- and low-HVEM expression were constructed. CD4+ cells were co-cultured with ovarian cancer (OC) cells, and the expressions of IL-2 and TGF-β1 in the supernatant of cells were detected by ELISA, and western blot was used to detect the expressions of STAT5, p-STAT5, and Foxp3. The results indicated that the number of Treg cells in the peripheral blood of OC patients increased, and the expression of HVEM increased, the two have a certain correlation. At the same time, the overexpression of HVEM promoted the expression of cytokines IL-2 and TGF- β1, promoted the activation of STAT5 and the expression of Foxp3, leading to an increase in the positive rate of Treg, while the HVEM gene silence group was just the opposite. Our results showed that the expression of HVEM in OC cells has a positive regulation effect on Tregs through the STAT5/Foxp3 signaling pathway. To provide experimental basis and related mechanism for the clinical treatment of ovarian cancer.
Successful treatment of advanced muscle-invasive bladder cancer with the combined therapy of toripalimab and chemotherapy: a case report
Authors: Dian Xia , Kun Liu , Xin Wang , SongBai Yan , Qi Liu , Liangkuan Bi
Published: August 2022

Bladder cancer is the most common malignancy in the urinary system, and muscle-invasive bladder cancer (MIBC) accounts for 25–30% among all types of bladder cancers. Although MIBC can be treated by surgery and chemotherapy, favorable outcomes can still not be obtained. In recent years, the emergence of immunotherapy represented by programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1) inhibitors and other immune checkpoint inhibitors provides attractive prospects for the treatment of advanced bladder cancer. PD-1/PD-L1 inhibitors can block the binding of PD-1/PD-L1, which can block negative immunomodulatory signals, thereby improving anti-tumor immune activity. In this article, we reported a case of advanced MIBC who achieved complete pathological remission after receiving the combined therapy of toripalimab and chemotherapy, which could provide clinical data for the treatment of bladder cancer with triprizumab.
Successful salvage therapy using high-dose furmonertinib (AST2818) for non–small-cell lung cancer after Osimertinib resistance: a case report
Authors: Cheng Daoan , Tang Shuxian , Li Dong , Zhao Weiqing , Wei Wei , Fang Cheng , Ji Mei
Published: August 2022

Osimertinib, the third generation of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors, responds well to advanced non–small-cell lung cancer (NSCLC) with the EGFR T790M mutation. However, resistance to osimertinib would inevitably occur. We report a case of an advanced NSCLC patient after osimertinib resistance who was successfully treated by high-dose furmonertinib (AST2818) at 160 mg. The patient initially received the GCP regimen for 11 months and displayed partial response. The patient received osimertinib 80 mg at the time of progression with a stable clinical and radiological response lasting only 7 months. Subsequently, she was commenced on furmonertinib 160 mg once daily. After 2 weeks of furmonertinib, the patient’s tumor was markedly smaller on a follow-up chest CT scan, and her respiratory symptoms also improved. What shocked us was that after a month’s re-examination of the cranial MRI, the intracranial lesions wholly disappeared. This report provides a case of the successful rescue of osimertinib-resistant NSCLC patients by oral administration of high-dose furmonertinib 160 mg daily, providing a new treatment option for osimertinib-resistant patients.
Oxycodone decreases anxiety-like behavior in the elevated plus-maze test in male and female rats
Authors: Bruijnzeel Adriaan W. , Behnood-Rod Azin , Malphurs Wendi , Chellian Ranjithkumar , Caudle Robert M. , Febo Marcelo , Setlow Barry , Neubert John K.
Published: August 2022

The prescription opioid oxycodone is widely used for the treatment of pain in humans. Oxycodone misuse is more common among people with an anxiety disorder than those without one. Therefore, oxycodone might be misused for its anxiolytic properties. We investigated if oxycodone affects anxiety-like behavior in adult male and female rats. The rats were treated with oxycodone (0.178, 0.32, 0.56, or 1 mg/kg), and anxiety-like behavior was investigated in the elevated plus-maze test. Immediately after the elevated plus-maze test, a small open field test was conducted to determine the effects of oxycodone on locomotor activity. In the elevated plus-maze test, oxycodone increased the percentage of time spent on the open arms, the percentage of open arm entries, time on the open arms, open arm entries, and the distance traveled. The males treated with vehicle had a lower percentage of open arm entries than the females treated with vehicle, and oxycodone treatment led to a greater increase in the percentage of open arm entries in the males than females. Furthermore, the females spent more time on the open arms, made more open arm entries, spent less time in the closed arms, and traveled a greater distance than the males. In the small open field test, treatment with oxycodone did not affect locomotor activity or rearing. Sex differences were observed; the females traveled a greater distance and displayed more rearing than the males. In conclusion, oxycodone decreases anxiety-like behavior in rats, and oxycodone has a greater anxiolytic-like effect in males than females.
Cementless primary or revision stem in revision hip arthroplasty for aseptic stem loosening with Paprosky type I/II femoral defect?
Authors: Pai Fu-Yuan , Arthur Chou Te-Feng , Ma Hsuan-Hsiao , Chang Wei-Lin , Tsai Shang-Wen , Chen Cheng-Fong , Wu Po-Kuei , Chen Wei-Ming
Published: August 2022

Background:

The use of primary or revision stem during revision total hip arthroplasty (THA) for aseptic stem loosening with Paprosky type I/II femoral defect remains controversial. The aim of this study was to compare the outcomes of patients who underwent revision THA with a primary or revision stem.

Methods:

We retrospectively reviewed 78 patients who received revision THA for aseptic stem loosening using primary (N = 28) or revision stems (N = 50). The bone defects were classified as Paprosky type I or II. The mean follow-up duration was 72.3 ± 34.7 months. The primary outcome domains included surgical complications and implant failures. The secondary outcome domains included medical complications, 30- and 90-day readmission, and Harris hip score (HHS).

Results:

The use of revision stem was associated with a higher incidence than primary stem of patient complications (60.0% vs. 32.1%, p = 0.018), including intraoperative femur fracture (28.0% vs. 7.1%, p = 0.029) and greater trochanter fracture (16.0% vs. 0%, p = 0.045). The implant survival rate was comparable between groups. HHS at the final follow-up was similar.

Conclusion:

With a lower risk of surgical complications and a similar rate of mid-term implant survival, cementless primary stem appears superior to revision stem in revision THA for aseptic stem loosening with Paprosky type I/II femoral defect.
Efficacy and safety of microwave ablation and radiofrequency ablation in the treatment of hepatocellular carcinoma: A systematic review and meta-analysis
Authors: Dou Zhimin , Lu Fei , Ren Longfei , Song Xiaojing , Li Bin , Li Xun
Published: August 2022

Background:

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. Surgical resection is often only possible in the early stages of HCC and among those with limited cirrhosis. Radiofrequency ablation and Microwave ablation are 2 main types of percutaneous thermal ablation for the treatment of HCC. The efficacy and safety between these 2 therapy methods are still under a debate.

Objective:

To compare the efficacy and safety of Radiofrequency ablation and Microwave ablation in treating HCC.

Methods:

PubMed, EMBASE, the Cochrane databases and Web of Science were systematically searched. We included randomized controlled trials and cohort studies comparing the efficacy and safety of Radiofrequency ablation and Microwave ablation in HCC patients. Outcome measures on local tumor progression, complete ablation, disease-free survival, overall survival, or major complications were compared between the 2 groups. The random effect model was used when there was significant heterogeneity between studies, otherwise the fixed effect model was used.

Results:

A total of 33 studies, involving a total of 4589 patients were identified, which included studies comprised 7 RCTs, 24 retrospective observational trials, and 2 prospective observational trial. Microwave ablation had a lower local tumor progression than Radiofrequency ablation in cohort studies (OR = 0.78, 95% CI 0.64–0.96, P = .02). Complete ablation rate of Microwave ablation was higher than that of Radiofrequency ablation in cohort studies (OR = 1.54, 95% CI 1.05–2.25, P = .03). There was no significant difference in overall survival and disease-free survival between the 2 groups. Meta-analysis showed that there was no significant difference in the main complications between Microwave ablation and Radiofrequency ablation.

Conclusions:

Microwave ablation has higher complete ablation and lower local tumor progression than Radiofrequency ablation in the ablation treatment of HCC nodules. There was no significant difference in overall survival between the 2 therapy methods.
Successful treatment of severe ARDS caused by accidental inhalation of nitric acid fumes with veno-venous ECMO: A case report and literature review
Authors: Wang Qian , Zhu Junchen , Chen Lvlin , He Yan , Li Hui , Lan Ying , Huang Chao , Peng Liyuan
Published: August 2022

Rationale:

The treatment of severe acute respiratory distress syndrome caused by accidental inhalation of nitric acid fumes is challenging. Few successful cases have been reported in literature. Owing to the development of extracorporeal life support, extracorporeal membrane oxygenation (ECMO) may play an important role in treatment.

Patient concerns:

A 40-year-old man was accidentally exposed to nitric acid fumes for 10 minutes in a factory. Mild throat irritation and dyspnea occurred 3.5 hours after exposure. Severe dyspnea recurred approximately two hours later. Chest computed tomography revealed bilateral interstitial edema. Tracheal intubation and mechanical ventilation were provided when the non-invasive ventilator failed to support the patient. However, his vital signs, respiratory function, and circulation were aggravated.

Diagnosis:

Aspiration pneumonia (inhalation of nitric acid fumes), acute respiratory distress syndrome, and hypertension.

Interventions:

Veno-venous ECMO (VV-ECMO) was started 6 hours after exposure at the intensive care unit. During VV-ECMO, hypoxia improved. However, chest radiography revealed aggravated pulmonary edema. Prone positioning under ultrasound monitoring and high-dose methylprednisolone were administered on the first day. Nebulization and fiberoptic bronchoscopy for airway management were performed on the second day after the exposure. Pulmonary secretions were significantly reduced 48 hours later.

Outcomes:

The patient was weaned off V-V ECMO after 6 days, achieved the standard of extubation after 9 days, and was discharged without serious pulmonary or infectious complications after 12 days of hospitalization. Three weeks after discharge, the patient’s lung function showed a slight decline in the diffusion function. Two months after discharge, the patient’s lung function returned to normal.

Lesson:

Early ECMO combined with prone positioning and visualized management through ultrasonography can better improve the prognoses of patients and promote lung function recovery.
BDNF val66met genotype is not associated with psychological distress: A cross-sectional study in Indonesian Pharmacy young adults
Authors: Ng Henry , Alfian Sofa Dewi , Abdulah Rizky , Barliana Melisa I.
Published: August 2022

The number of mental disorders has been increasing but has yet to receive sufficient attention. In particular, healthcare students and professionals tend to have high stress burden. Finding the root cause of psychological distress is important to formulate a method for early detection and prevention. The association of brain-derived neurotrophic factor val66met polymorphism to neuropsychiatric disorders has been widely studied. To study the interplay between brain-derived neurotrophic factor val66met polymorphism and sociodemographic factors in the pathogenesis of psychological distress among Indonesian Pharmacy students. Level of psychological distress and sociodemographic profiling was collected by using the Kessler Psychological Distress Scale and sociodemographic questionnaires, respectively. Genotyping was performed using polymerase chain reaction-amplified refractory mutation system. Pearson’s chi square and binomial logistic tests were used to evaluate the correlation. This study recruited 148 participants. The psychological distress levels of the participants were well (27.03%), mild (37.16%), moderate (25.00%), and severe (10.81%). Genotypic distributions were AA (25.67%), GA (50.68%), and GG (23.65%). No statistical significance between genotype and psychological distress was found in the study (P = .076). The sociodemographic factors also showed non significance, except for the source of tuition fee among women students (P = .049). Psychological distress is not affected by genotypic and sociodemographic factors. Further confirmatory research with larger and broader populations is required.
Community pharmacy-based SOAP notes documentation
Authors: Sapkota Binaya , Shrestha Rajiv , Giri Shimonraj
Published: August 2022

There is still scarce and sparse evidence regarding documentation of the subjective, objective, assessment and plan (SOAP) note in community pharmacies despite its long implementation history in clinical and academia settings. Hence, we aimed to document and maintain SOAP notes for individual patients visiting community pharmacies for their health problems.

We conducted a community-based cross-sectional study at 2 community pharmacies in Nepal from July to December 2019. We recruited 400 patients from all age groups suffering from any health problem using simple random sampling. Patients’ subjective complaints were retrieved from their respective prescriptions and verified by interviewing them. Data were collected on the standard format of the SOAP notes and all data related to patients’ subjective and objective evaluations, and assessments and plans were descriptively analyzed with R programming 4.0.3. Drug interaction profile was checked with the Medscape Drug Interaction Checker.

A total of 87 (21.8%) patients aged 42 to 51 years participated in the research, out of whom 235 (58.8%) were female, 208 (52%) illiterate, 359 (89.8%) were facing mild polypharmacy, and 40 (9.9%) were suffering from joint, leg, ankle, and knee pain. There were 41 minor (11.4%), 130 major (32.7%), and 3 severe (0.9%) drug interaction cases (i.e., medication-related problems), with 11 (2.8%) occurring between amlodipine and metformin, which required close monitoring. There were 226 (56.5%) cases with follow-up planned for the patients when necessary.

This novel approach in documenting SOAP notes at community pharmacies during dispensing would be an extended form of the same being applied in clinical settings. Hence, this would open a new arena for the community pharmacists to expand their professionalism beyond the clinical and academia by documenting patients’ complex disease and medication profiles in their documentation.
The effects of hydroxyapatite implantation with the autogenous sclera cap: A cohort study
Authors: Zhou Hongwei , Zhu Chongyan , Chen Kai , Zheng Xiang
Published: August 2022

We performed a novel hydroxyapatite (HA) prosthesis implantation method in which an HA implant was implanted into the scleral shell with an autogenous scleral cap.

Twenty-six patients who had undergone the novel HA prosthesis implantation method and 32 patients who had undergone traditional HA prosthesis implantation were retrospectively reviewed. The postoperative activity of the artificial eye was measured by the Hirschberg test combined with arc perimetry. The visual analog score (VAS) was used to evaluate 2-month postoperative pain and 2-month postoperative discomfort. HA implant vascularization was measured with enhanced magnetic resonance imaging (MRI) 2 and 6 months after the operation. The enhancement volume (V
E) and the volume of the HA implant (V
HA) were measured. All cases were followed up for 2 years. Measurement data were processed using SAS 6.12.

There was a statistically significant difference (P = .016) between the percentages of excellent grade in the two groups. Two months after implantation, the median pain scores of the study and control groups were 2 and 2.5, respectively, and there was a statistically significant difference (W = 585.0, P = .004); there was a statistically significant difference (W = 535.5, P = .000) between the median discomfort scores of the study group (score = 1) and control group (score = 2); the mean VE/VHA values of the study and control groups were 0.3075 and 0.1535, respectively, and there was a statistically significant difference (t = −8.196, P = .000). Six months after implantation, the V
E/V
HA values of the study and control groups were 0.9686 and 0.5934, respectively, and there was a statistically significant difference (W = 549.0, P = .000). Within 2 years of postoperative follow-up, there were no serious complications in the study group.

In the study group, in which the hydroxyapatite implant was implanted into a preserved scleral shell with unaltered muscles and covered with an autogenous scleral cap, postoperative activity and the fibrovascularization of the HA implant were significantly increased, and postoperative pain and discomfort were significantly reduced.
Status and influencing factors of patients with kinesiophobia after insertion of peripherally inserted central catheter: A cross-sectional study
Authors: Liuyue Wang , Juxin Gong , Chunlan Huang , Junli Li , Liucui Chen , Xialu Zhang , Qiujiao Liao , Fangyin Liu
Published: August 2022

This study aimed to investigate the current status and influencing factors of kinesiophobia in patients after insertion of peripherally inserted central catheter (PICC).

A total of 240 patients with PICC were included. Their postinsertion status and influencing factors were investigated using the general information questionnaire, Tampa Scale of Kinesiophobia (TSK), Medical Coping Modes Questionnaire, Numerical Rating Scale, and Self-rating Anxiety Scale.

The mean TSK score was 36.49 ± 4.19 points, and 89 patients (37.08%) had kinesiophobia. Multiple linear regression analysis showed that factors such as education level, age, monthly income level, catheterization history, face, pain level, anxiety, and number of needle insertions influenced postoperative kinesiophobia in patients with PICC (P < .05). The total variation in the TSK score was 71.8%.

The incidence of kinesiophobia was relatively high after PICC insertion. The medical staff needs to undertake targeted intervention measures to help minimize kinesiophobia after PICC insertion, allowing patients to perform scientifically correct functional exercises and attain physical recovery.
Molecular and clinical features of a potential immunotherapy target ELK3 in glioma
Authors: Xu Hao , Zhang Li , Gao Jin , Wang Jiajing , Wang Yihao , Xiao Dongdong , Chai Songshan
Published: August 2022

Glioma represents the most prevalent malignant primary brain cancer, and its treatment remains a tremendous challenge. Novel and efficient molecular targets are therefore required for improving diagnosis, survival prediction, and treatment outcomes. Additionally, some studies have shown that immunity is highly associated with glioma progression. Our study aimed to investigate the clinicopathological features, prognostic significance, and immunotherapeutic targetability of ELK3, a member of the erythroblast transformation-specific transcription factor family, in glioma using bioinformatics analyses. ELK3 transcript levels in glioma tissues were evaluated using the Gene Expression Omnibus and The Cancer Genome Atlas databases. Clinical and transcriptomic data of The Cancer Genome Atlas glioma patients were analyzed to identify the molecular and clinical characterizations of ELK3. The prognostic significance of ELK3 was assessed using Cox regression and Kaplan–Meier analysis. The biological pathways related to ELK3 expression were identified by gene set enrichment analysis. The relationships between ELK3 and inflammatory responses, immune cell infiltration, and immune checkpoints were explored using canonical correlation analysis and gene set variation analysis. ELK3 was upregulated in gliomas, and its high expression was correlated with advanced clinicopathologic features and unfavorable prognosis. Gene set enrichment analysis revealed that several immune-related pathways were tightly linked to high ELK3 expression. gene set variation analysis and correlograms demonstrated that ELK3 was robustly associated with inflammatory and immune responses. Correlation analyses indicated that ELK3 was positively associated with infiltrating immune cells and synergistic with several immune checkpoints. ELK3 may serve as a novel marker of poor prognosis and a potential immunotherapeutic target in glioma.
Effects of omega-3 fatty acid on major cardiovascular outcomes: A systematic review and meta-analysis
Authors: Yu Fangyu , Qi Shun , Ji Yanan , Wang Xizhi , Fang Shaohong , Cao Ruokui
Published: August 2022

Background:

The effects of omega-3 fatty acid on cardiovascular health obtained inconsistent results. A systematic review and meta-analysis were therefore conducted to assess the effects of omega-3 fatty acid supplementation for primary and secondary prevention strategies of major cardiovascular outcomes.

Methods:

The databases of PubMed, Embase, and the Cochrane library were systematically searched from their inception until September 2020. Relative risks (RRs) with 95% confidence intervals were used to assess effect estimates by using the random-effects model.

Results:

Twenty-eight randomized controlled trials involving 136,965 individuals were selected for the final meta-analysis. Omega-3 fatty acid was noted to be associated with a lower risk of major cardiovascular events (RR, 0.94; 95% CI, 0.89–1.00; P = .049) and cardiac death (RR, 0.92; 95% CI, 0.85–0.99; P = .022). However, no significant differences was noted between omega-3 fatty acid and the control for the risks of all-cause mortality (RR, 0.97; 95% CI, 0.92–1.03; P = .301), myocardial infarction (RR, 0.90; 95% CI, 0.80–1.01; P = .077), and stroke (RR, 1.02; 95% CI, 0.94–1.11; P = .694).

Conclusions:

Major cardiovascular events and cardiac death risks could be avoided with the use of omega-3 fatty acid. However, it has no significant effects on the risk of all-cause mortality, myocardial infarction, and stroke.
Sensor acquired reachable workspace in the elderly population: A cross-sectional observational study
Authors: Chan Vicky , Thai Richard , Vartanian Revik , Kim Min Su , Hatch Maya N. , Koh Jason , Han Jay J.
Published: August 2022

The elderly population experiences a decline in upper extremity range of motion (ROM), impairing activities of daily living. The primary mode of quantification is by goniometer measurement. In this cross-sectional observation study, we investigate a sensor-acquired reachable workspace for assessing shoulder ROM decline in an elderly population in comparison to traditional measurements.

Sixty-one healthy subjects aged ≥ 65 years were included and compared to a cohort of 39 younger subjects, aged 20 to 64. A sensor acquired reachable workspace using a Kinect motion capture camera measured the maximum reaching ability of both arms while in a seated position, measured in m2 and normalized to arm length to calculate a novel score defined as a relative surface area. This score approximates range of motion in the upper extremity. This measurement was compared to goniometer measurements, including active ROM in shoulder flexion and abduction.

Total RSA shows moderate to strong correlation between goniometer in flexion and abduction in the dominant arm (R = 0.790 and R = 0.650, P < .001, respectively) and moderate correlations for the nondominant arm (R = 0.622 and R = 0.615, P < .001). Compared to the younger cohort, the elderly population demonstrated significantly reduced total RSA in the dominant arm (meanelderly = 0.774, SD = 0.09; meanyounger = 0.830, SD = 0.07, P < .001), with significant reductions in the upper lateral quadrant in both arms (dominant: meanelderly = 0.225, SD = 0.04; meanyounger = 0.241, SD = 0.01; P < .001; nondominant: meanelderly = 0.213, SD = 0.03; meanyounger = 0.228, SD = 0.01; P = .004). The test-retest reliability was strong for both dominant and nondominant total RSA (ICC > 0.762).

The reachable workspace demonstrates promise as a simple and quick tool for clinicians to assess detailed and quantitative active shoulder ROM decline in the elderly population.
Unicompartmental knee arthroplasty is superior to high tibial osteotomy for the treatment of medial unicompartmental osteoarthritis: A systematic review and meta-analysis
Authors: Huang Linke , Xu Yinglong , Wei Linhua , Yuan Guangzhi , Chen Weiwei , Gao Shiyao , Liu Wei , Tan Zhen , Zhao Jinmin
Published: August 2022

Background:

Unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) are widely used for the treatment of medial unicompartmental knee osteoarthritis (OA). However, the best approach remains controversial. This study aimed to present a systematic review and a meta-analysis to directly compare the clinical outcomes between HTO and UKA. We hypothesized that the clinical outcomes after UKA and HTO would be similar.

Methods:

Electronic databases (Web of Science, PubMed, Embase, CENTRAL, and Biosis Preview) were searched for related studies published before November 30, 2021. Retrospective and prospective studies that directly compared the postoperative outcomes between UKA and HTO were included. Odds ratio (ORs) and 95% confidence interval (CIs) for complications, revision to total knee arthroplasty (TKA), and weighted mean difference (MD) and 95% CIs in range of motion (ROM), pain, walking speed and function score were evaluated. Two reviewers independently assessed the quality of the studies. Subgroup and sensitivity analyses were performed to explore the heterogeneity.

Results:

Twenty-three retrospective and 6 prospective studies were included. A total of 3004 patients (3084 knees) were evaluated for comparison. Complications (OR, 4.88, 95% CI: 2.92–6.86) were significantly greater in the HTO group than in the UKA group. Postoperative function scores including Lysholm score (MD, −2.78, 95% CI: −5.37 to −0.18) and Hospital for Special Surgery (HSS) score (MD, −2.80, 95% CI: −5.39 to −0.20) were significantly lower in the HTO group than the UKA group. The postoperative ROM was similar between HTO and mobile-bearing UKA (MD, −3.78, 95% CI: −15.78 to 8.22). However, no significant differences were observed between the HTO and UKA group in terms of postoperative pain, walking speed, and revision to TKA.

Conclusions:

UKA is superior to HTO in minimizing complications and enhancing postoperative function scores. Mobile-bearing UKA has a similar ROM compared with HTO. Both HTO and UKA provide satisfactory clinical outcomes in terms of walking speed, relieving pain, and revision to TKA. UKA appears to be more suitable for the elderly, and both mobile-bearing UKA and HTO are viable surgical options for younger active individuals.
Factors associated with death places among elderly patients receiving home-based care
Authors: Chiang Jui-Kun , Kao Yee-Hsin
Published: August 2022

The quality of end-of-life (EOL) care for patients receiving home-based care is a critical issue for health care providers. Dying in a preferred place is recognized as a key EOL care quality indicator. We explore the factors associated with death at home or nursing facilities among elderly patients receiving home-based care.

This retrospective study was based on a medical chart review between January 2018 and December 2019 of elderly patients. Multivariate analysis was conducted by fitting multiple logistic regression models with the stepwise variable selection procedure to explore the associated factors.

The 205 elderly patients receiving home-based care were enrolled for analysis. The mean participant age was 84.2 ± 7.8 years. Multiple logistic regression indicated that significant factors for elderly home-based patients who died at home or nursing facilities were receiving palliative service (odds ratio [OR], 3.21; 95% confidence interval [CI], 1.37–7.51; P = .007), symptoms of nausea or vomiting (OR, 5.38; 95% CI, 1.12–25.84; P = .036), fewer emergency department visits (OR, 0.07; 95% CI, 0.03–0.16; P < .001), and less intravenous third-generation cephalosporin use (OR, 0.15; 95% CI, 0.03–0.75; P = .021) in the last month of life. Patients with dementia had a lower probability of dying at home or nursing facilities than patients with other diagnosis (OR, 0.34, 95% CI, 0.13–0.90; P = .030).

Among elderly home-based patients, receiving palliative service, with nausea or vomiting, and fewer emergency department visits in the last month of life favored home or nursing facilities deaths. Practitioners should be aware of the factors with higher probabilities of dying at home and in nursing facilities. We suggested that palliative services need to be further developed and extended to ensure that patients with dementia can receive adequate EOL care at home and in nursing facilities.