bluuebunny/crossref_metadata_2025 huggingface dataset:
Machine Learning Differentiates Extracorporeal Membrane Oxygenation Mortality Risk Profiles Among Trauma Patients
Authors: Campbell Bryan R. , Rooney Alexandra S. , Krzyzaniak Andrea , Calvo Richard Y. , Checchi Kyle D. , Carroll Alyssa N. , Sise Michael J. , Bansal Vishal , Krzyzaniak Michael J.
Published: May 2024

Background

Extracorporeal membrane oxygenation (ECMO) is resource intensive with high mortality. Identifying trauma patients most likely to derive a survival benefit remains elusive despite current ECMO guidelines. Our objective was to identify unique patient risk profiles using the largest database of trauma patients available.

Methods

ECMO patients ≥16 years were identified using Trauma Quality Improvement Program data (2010-2019). Machine learning K-median clustering (ML) utilized 101 variables including injury severity, demographics, comorbidities, and hospital stay information to generate unique patient risk profiles. Mortality and patient and center characteristics were evaluated across profiles.

Results

A total of 1037 patients were included with 33% overall mortality, mean age 32 years, and median ISS = 26. The ML identified 3 unique patient risk profile groups. Although mortality rates were equivalent across the 3 groups, groups were distinguished by (Group 1) young (median 25 years), severely injured (ISS = 34) patients with thoracic and head injuries (99%) via blunt mechanism (93%), and a high prevalence of ARDS (77%); (Group 2) relatively young (median 30 years) and moderately injured (ISS = 22) patients with exposure-related injuries (11%); and (Group 3) older (median 46 years) patients with a high proportion of comorbidities (69%) and extremity injuries (100%). There were no differences based on center ECMO volume, teaching status, or ACS-Level across all 3 groups.

Conclusion

Machine learning compliments traditional analyses by identifying unique mortality risk profiles for trauma patients receiving ECMO. These details can further inform treatment guidelines, clinical decision making, and institutional criteria for ECMO usage.
Examining Factors Contributing to Motorcycle Collisions with Left-Turning Vehicles at Urban Intersection Locations
Authors: Haule Henrick , Dumbaugh Eric
Published: May 2024

Motorcycle crashes account for a significant proportion of traffic-related fatalities on U.S. roadways. Compared with motor vehicles, motorcycles traveling straight ahead are more susceptible to collisions with left-turning vehicles at intersections (note – in a system where traffic travels on the right-hand side of the road). The limited knowledge of the causes and influences of this specific type of crash deters efforts to improve motorcycle safety and is partly influenced by two issues. First, significant variables are unknown; second, motorcycles comprise a small proportion of vehicles in the traffic stream. This study sought to understand the factors that may contribute to the disproportionate crash risk left-turning vehicles pose for motorcyclists while accounting for the imbalance of vehicle proportions. Data containing motorcycle-motor vehicle and motor vehicle-motor vehicle crashes involving left-turning motor vehicles at intersections in South Florida were collected from 2015 to 2017. The study applied logistic regression on a balanced dataset generated using the random oversampling technique. The proposed model improved the predictive accuracy and enabled the identification of factors contributing to motorcycle crashes with left-turning vehicles. A Bayesian network analysis was also applied to the balanced data to analyze the interrelationship of factors associated with motorcycle crashes with left-turning vehicles. Results indicated that the type of intersection and traffic control, time of day, age of drivers, sex of the motorcyclist, roadway type, and weather were significantly associated with motorcyclists’ susceptibility to collisions with left-turning vehicles. Recognizing these attributes could help devise engineering measures and policies for promoting motorcycle safety.
Effects of Trauma Cue Exposure and Posttraumatic Stress Disorder (PTSD) on Affect and Cannabis Craving in Cannabis Users With Trauma Histories: Use of Expressive Writing as an Online Cue-Reactivity Paradigm: Effets de l'exposition aux signaux traumatiques et du SSPT sur l'affect et le besoin de cannabis chez les consommateurs de cannabis ayant des antécédents de traumatismes : utilisation de l'écriture expressive comme paradigme de réactivité en ligne
Authors: DeGrace Sarah , Barrett Sean P. , Yakovenko Igor , Tibbo Philip G. , Romero-Sanchiz Pablo , Carleton R. Nicholas , Snooks Thomas , Rudnick Abraham , Stewart Sherry H.
Published: May 2024

Objectives

Posttraumatic stress disorder (PTSD) and cannabis use disorder (CUD) commonly co-occur. Conditioned associations between psychological trauma cues, distress, cannabis use, and desired relief outcomes may contribute to the comorbidity. These conditioned associations can be studied experimentally by manipulating trauma cue exposure in a cue-reactivity paradigm (CRP) and examining effects on affective and cognitive outcomes in participants with and without PTSD. However, traditional CRPs take place in-lab limiting recruitment/power. We aimed to examine the effects of CRP condition (trauma and neutral) and PTSD group (likely PTSD+ and PTSD−) on affective and craving outcomes using a stand-alone online expressive writing CRP.

Methods

Participants ( n = 202; 43.6% male; Mage = 42.94 years, SD = 14.71) with psychological trauma histories and past-month cannabis use completed a measure of PTSD symptoms (PTSD Checklist-5 for DSM-5 [PCL-5]) and were randomized to complete either a trauma or neutral expressive writing task. Then they completed validated measures of affect (Positive and Negative Affect Schedule-Short Form [PANAS-SF]) and cannabis craving (Marijuana Craving Questionnaire-Short Form [MCQ-SF]).

Results

Linear mixed models tested the hypothesized main and interactive effects of CRP condition (trauma and neutral) and PTSD group (likely PTSD+ and PTSD−) on negative and positive affect (PANAS-SF) and cannabis craving dimensions (MCQ-SF). The hypothesized main effects of trauma versus neutral expressive writing were found for negative affect and the expectancy dimension of cannabis craving and of PTSD group for negative affect and all cannabis craving dimensions; no interactions were observed.

Conclusions

Expressive writing appears a useful online CRP. Interventions focused on reducing negative affect and expectancy craving to trauma cues may prevent/treat CUD among cannabis users with PTSD.

Plain Language Summary Title

The Use of an Online Expressive Writing as a Trauma Cue Exposure: Effects on Craving and Emotions
Prevalence and Predictors of Anxiety and Depression in Indian Patients with  Type 2 Diabetes
Authors: Tripathi Pramod , Sharma Baby , Kadam Nidhi , Biswas Mayurika Das , Tiwari Diptika , Vyawahare Anagha , Kathrikolly Thejas , Kuppusamy Maheshkumar , Vijayakumar Venugopal
Published: May 2024

Background:

Numerous investigations indicate the presence of a reciprocal association between type 2 diabetes (T2D) and a range of mental health conditions. However, research on the factors that contribute to depression and anxiety in T2D patients in India is scarce.

Purpose:

The present study aims to identify the prevalence and predictors of depression and anxiety in patients with T2D in India.

Methods:

A cross-sectional study that included 2,730 patients with T2D was conducted at the Freedom from Diabetes Clinic in Pune, India. Anxiety and depression were measured by the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorders-7 (GAD-7) Scale. Binary logistic regression was applied to identify the factors predicting anxiety and depression.

Results:

The prevalence of depression and anxiety were 20.3% and 17.3%, respectively. The major predictors of anxiety and depression were female gender, obesity, unmarried marital status, poor glycaemic control and the presence of comorbid conditions.

Conclusion:

This study’s findings highlight a significant prevalence of depression and anxiety among patients with T2D in India, with key predictors including gender, obesity, marital status, glycaemic control and comorbid conditions. These findings highlight the critical need for integrated mental health support in routine diabetes care to manage depression and anxiety.
U.S. Parental Vaccine Hesitancy and the COVID-19 Vaccine: A Scoping Review
Authors: Baker Christina , Cook Paul F.
Published: May 2024

Parental vaccine hesitancy has been a hotly debated issue long before the COVID-19 pandemic. Still, the emergence of a new vaccine during this public health crisis made even pro-vaccine individuals reconsider vaccines for their children. This scoping review was conducted to understand why parents expressed hesitancy towards the COVID-19 vaccine for children under 12 years old. The search included primary sources of evidence published in English from 2020–2022. A final 41 articles met the criteria. Overall, more vaccine-hesitant characteristics were non-white, female, lower education level, lower income, on public insurance, conservative political affiliation, younger age, and rural residence. Concerns affecting confidence in the vaccine were the risk of possible side effects and lack of trust in the development of the emergency approval of the vaccine. School nurses can acknowledge parental fears and provide parents with evidence-based information when communicating with them about vaccinations.
Improving explanation of motor disability with diffusion-based graph metrics at onset of the first demyelinating event
Authors: Foster Michael A , Prados Ferran , Collorone Sara , Kanber Baris , Cawley Niamh , Davagnanam Indran , Yiannakas Marios C , Ogunbowale Lola , Burke Ailbhe , Barkhof Frederik , Wheeler-Kingshott Claudia AM Gandini , Ciccarelli Olga , Brownlee Wallace , Toosy Ahmed T
Published: May 2024

Background:

Conventional magnetic resonance imaging (MRI) does not account for all disability in multiple sclerosis.

Objective:

The objective was to assess the ability of graph metrics from diffusion-based structural connectomes to explain motor function beyond conventional MRI in early demyelinating clinically isolated syndrome (CIS).

Methods:

A total of 73 people with CIS underwent conventional MRI, diffusion-weighted imaging and clinical assessment within 3 months from onset. A total of 28 healthy controls underwent MRI. Structural connectomes were produced. Differences between patients and controls were explored; clinical associations were assessed in patients. Linear regression models were compared to establish relevance of graph metrics over conventional MRI.

Results:

Local efficiency ( p = 0.045), clustering ( p = 0.034) and transitivity ( p = 0.036) were reduced in patients. Higher assortativity was associated with higher Expanded Disability Status Scale (EDSS) (β = 74.9, p = 0.026) scores. Faster timed 25-foot walk (T25FW) was associated with higher assortativity (β = 5.39, p = 0.026), local efficiency (β = 27.1, p = 0.041) and clustering (β = 36.1, p = 0.032) and lower small-worldness (β = −3.27, p = 0.015). Adding graph metrics to conventional MRI improved EDSS ( p = 0.045, Δ R2 = 4) and T25FW ( p < 0.001, Δ R2 = 13.6) prediction.

Conclusion:

Graph metrics are relevant early in demyelination. They show differences between patients and controls and have relationships with clinical outcomes. Segregation (local efficiency, clustering, transitivity) was particularly relevant. Combining graph metrics with conventional MRI better explained disability.
Diverting ostomy prior to neoadjuvant treatment in rectal cancer should be used selectively: A retrospective single-center cohort study
Authors: Valdimarsson Valentinus , Munshi Eihab , Lydrup Marie-Louise , Jutesten Henrik , Samuelsson Carolina , Buchwald Pamela
Published: May 2024

Background:

Rectal cancer patients commonly benefit from neoadjuvant therapy before resection surgery. For these patients, an elective ostomy diversion is frequently considered, despite the absence of conclusive evidence when a diversion is advantageous. This is a retrospective observational single-center study on a 4-year consecutive rectal cancer cohort undergoing neoadjuvant therapy, aiming at improving the understanding of risks and benefits associated with ostomy diversion.

Material and Method:

Baseline characteristics, tumor-specific data, clinical events, and outcomes were collected using the Swedish Colorectal Cancer Registry and medical records.

Results:

Thirty-two (30.2%) of the 106 included patients presented with endoscopic impassable tumors at diagnosis, of which 18 (56.2%) had diverting ostomy. Three out of 14 with impassable tumor and no diversion developed a bowel obstruction. None of the patients with an endoscopically passable tumor at diagnosis (n = 74) experienced a bowel obstruction. The elective diversions (n = 40) were not associated with serious complications (Clavien–Dindo grade ⩾ 3b). Patients with a diverting ostomy (n = 30) had similar time intervals from diagnosis to neoadjuvant treatment and to definite tumor resection as those without diversion but experienced more complex primary tumor resections in terms of blood loss and operation time.

Conclusion:

An elective diverting ostomy is a relatively safe procedure in rectal cancer patients requiring neoadjuvant therapy. More than one out of five non-diverted patients with endoscopically impassable rectal tumors developed bowel obstruction and would potentially have benefited from an elective diversion.
CircAGFG1 Promotes Ovarian Cancer Progression Through the miR-409-3 p/ZEB1 Axis
Authors: Luo Jie , Zhong Hua , Guo Mei , Xiao Peihong , Cao Rongyu , Zhao Mandan , Jing Yongping
Published: May 2024

Objectives

Circular RNAs (circRNAs) serve a crucial regulatory role in ovarian cancer (OC). Circular RNA ArfGAP with FG repeats 1 (circAGFG1) has been shown to be involved in promoting the progression of several cancers, containing triple-negative breast cancer, esophageal cancer and colorectal cancer. However, the function of circAGFG1 in OC is unclear.

Methods

Quantitative real-time reverse transcription PCR (RT-qPCR) was conducted to determine the expression levels of circAGFG1 and miR-409-3p. The proliferation and metastasis of cells were determined by colony formation assays, EdU assays, transwell assays and wound healing assays. In addition, a dual-luciferase reporter assay was performed to validate the mechanism between circAGFG1, miR-409-3p, and ZEB1.

Results

Our data suggested that circAGFG1 was significantly overexpressed in OC tissues compared to normal ovarian epithelial tissues. Overexpression of circAGFG1 was correlated with intraperitoneal metastasis, tumor recurrence and advanced stage. Additionally, circAGFG1 overexpression revealed a poor prognosis in OC patients. Knockdown of circAGFG1 suppressed the proliferation, invasion and migration of OC cells. Mechanistically, circAGFG1 acted as a sponge of miR-409-3p to enhance the expression level of zinc finger E-box binding homeobox 1 (ZEB1), thereby conferring OC cell proliferation, invasion and migration. Importantly, re-expression of ZEB1 effectively reversed the effects of circAGFG1 knockdown on OC cells.

Conclusions

In summary, our study indicated that circAGFG1 may act as a prognostic biomarker and potential therapeutic target for patients with OC.
Athlete monitoring perspectives of sports coaches and support staff: A scoping review
Authors: Timmerman Wouter P. , Abbiss Chris R. , Lawler Nathan G. , Stanley Mandy , Raynor Annette J.
Published: May 2024

Objectives

To map and summarise the sports coaches’ and support staff's perspectives on athlete monitoring to explore the breadth of literature, identify knowledge gaps and inform future research.

Design

Scoping review based on the Joanna Briggs Institute (JBI) methodology.

Methods

SPORTDiscus, MEDLINE, APA PsycInfo, and Embase databases were searched in English until 6 September 2022. The inclusion criteria were (1) coach(es) and/or support staff were explicitly questioned about their knowledge, perceptions, understanding, opinions, and/or applied practice of athlete monitoring; (2) results could be directly attributed to coach(es) and/or support staff; (3) primary research projects that are available as full-text. Exclusion criteria were applied for grey literature. The data were extracted into a custom-made data charting spreadsheet.

Results

From the 4381 identified records, 42 met the eligibility criteria. Almost all the studies were conducted within the Anglosphere and at the national or international level. The main reasons for coaches and support staff to implement athlete monitoring were to reduce injury and illness, inform the training program, and improve or maintain performance. While training load monitoring is generally seen as valuable the coaches and support staff acknowledged that there was no perfect scientific approach to monitoring athletes and believed it should be part of the bigger picture, emphasising communication.

Conclusions

There has been a recent surge in research demonstrating that athlete monitoring extends beyond quantitative information and encompasses non-quantified subjective information. This further substantiates that coaches and support staff will remain central to athlete monitoring, even amidst the anticipated technological progress.
Cross-border telework and the applicable labour law: The role of different connecting factors in determining objectively applicable law
Authors: Rosin Annika
Published: May 2024

In the case of cross-border employment, the applicable law is determined mainly according to habitual place of work. If this factor cannot be clarified, the engaging place of business of the employer determines the applicable law. Both factors can be set aside if the relationship is more closely connected to some other country.

Telework is performed outside the employers’ premises, and the determination of the exact workplace can be difficult. This again complicates the determination of the applicable law in cross-border cases. This article analyses how, in the case of cross-border telework, the applicable law should be determined.

It is argued that the exact system depends on the type of telework. If telework is performed in one country abroad, the habitual place of work determines the applicable law. If teleworker has at least two offices or manages his own working time, the second connecting factor applies. As the determination of the applicable law according to the engaging place of business is not considered to be sufficiently employee-protective, escape clause should be emphasised in the second case to guarantee the best employment protection to the employee.
Exploring the Influence of Village Social Capital and Rural Development on Farmers’ Entrepreneurial Decision-Making: Unveiling the Path to Local Entrepreneurship
Authors: Liu Jinfa , Qi Weixin , Yu Yawen , Han Yan , Zheng Donghui
Published: May 2024

This paper aims to comprehensively define village social capital, assess its multifaceted dimensions in relation to farmers’ entrepreneurial decision-making, and investigate the mediating role of rural development. The research sample consists of 14,133 farmers selected through a multi-stage proportional-to-size unequal probability sampling method. Data collection was carried out using questionnaires as part of the “Chinese Thousand Village Survey” project. Empirical analysis was conducted using binary logit and basic linear regression models, supplemented by probit models and other robustness testing methods. The findings indicate that village social capital exerts a significant and favorable influence on farmers’ entrepreneurial decision-making. Controlling for other variables, a unit increment in farmers’ village social network, village social participation, and village social trust is associated with a respective increase in farmers’ odds of entrepreneurial decision-making by 3.96, 5.42, and 16.28%. Village social trust emerges as the most influential factor. Additionally, rural harmony and rural economy partially mediate the relationship between village social capital and farmers’ entrepreneurial decision-making. This study contributes to a deeper understanding of the complex interplay between village social capital and farmers’ entrepreneurial decision-making, offering valuable guidance for farmers looking to leverage village social capital in their entrepreneurial endeavors. It lays a theoretical foundation for relevant entities to strengthen village social capital and cultivate a supportive environment for rural entrepreneurship. To our knowledge, this paper is among the earlier studies that investigate farmers’ entrepreneurial decision-making. Besides, the relationship between village social capital and rural development is rarely studied in the literature as two determinants of farmers’ entrepreneurial decision-making.
Diagnosis and Management of Verrucous Carcinoma of the Esophagus
Authors: Shi Jay , Wee Jon O. , Zhao Lei
Published: May 2024

Verrucous esophageal carcinoma is an extremely rare subtype of squamous cell carcinoma of the esophagus that is characterized by a friable exophytic mass but is often deceptively low-grade and superficially well-differentiated on mucosal biopsies, making pathologic diagnosis challenging. Distant metastasis is rare in these tumors. Therefore, early diagnosis is crucial as surgical resection is frequently curative. Conversely, delay in diagnosis can lead to extensive local invasion and result in severe morbidity and death. In this article, we will outline the history of verrucous esophageal carcinoma, review the current clinical understanding based on cases of verrucous carcinoma described thus far, and discuss recent advances in understanding of the pathogenesis of verrucous esophageal carcinoma that may aid in molecular diagnostics.
Absence & presence: The six racism-in-education-processes (‘the 6 REP’)
Authors: Jones Christopher
Published: May 2024

This article aims to explore the ways in which racial inequity in England education affects resilient minority (ReM) – that is, racially minoritised – students. Scholars argue racism simultaneously produces and normalises the lack of opportunities given to ReM students, shown within six key processes: (i) pre-university educational attainment, (ii) university application choices, (iii) university admissions process, (iv) degree completion and achievement, (v) graduate career prospects, and (vi) the racialised student experience. Each of these processes afford opportunity but are vulnerable to external factors (e.g. race and gender), thus students’ futures are ultimately constrained to uncontrollable aspects of their being. This is because racism manifests in both overt and covert ways leading administrators to believe a colour-blind and meritocratic system is beneficial for students, in turn creating deficit narratives. Thus, the author has called these stages the six Racism-in-Education-Processes (6 REP). Research has highlighted the impact of these processes, but few have amalgamated them altogether. Therefore, this paper deploys existing literature and the author’s theses using a Critical Race Theory analysis to critically examine the 6 REPs impact on Black African England students, to illustrate the absence of racial equity leads to the presence of racism.
Heated tobacco products- well known or well understood? A national cross-sectional study on knowledge, attitudes and usage in Pakistan
Authors: Irshad Hammad Atif , Jehanzeb Hamzah , Raja Sajjan , Saleem Umair , Shaikh Wamiq Ali , Shahzad Akmal , Amirali Atiqa , Iqbal Nousheen , Khan Javaid Ahmed
Published: May 2024

Background

Heated tobacco products (HTPs) are reshaping the tobacco industry and just recently, a plan was sought to regularize HTPs in Pakistan. Pakistan provides an intriguing case study in this context, as tobacco use is deeply ingrained in public use. To ensure that future evidence-based policy recommendations are grounded in the public’s knowledge, attitudes, and usage of HTPs, a nationwide survey must be conducted.

Methods

A cross-sectional study was conducted using an online-based questionnaire nationwide in Pakistan. The questionnaire was validated and distributed through convenience sampling. The questionnaire assessed participants’ knowledge, attitudes, and usage of HTPs. Descriptive statistics was used to describe participants’ response and linear regression was performed at a p-value of < 0.05 using SPSS version 26.

Results

In our sample of 1195 respondents (mean age of 33 years, 41.8% males and 58.2% females), 54.7% had previously heard about HTPs and 16.9% reported using HTPs at least once. Additionally, 38.24% were unsure of the legality of HTP use. Those with monthly household incomes of PKR 100,000 to 500,000, were more likely to have higher knowledge scores (OR:1.80[1.07–3.04]). On the other hand, males (OR:0.70 [0.55–0.89]) and respondents from Balochistan (OR:0.40 [0.22–0.71]) were more likely to have lower knowledge scores. The strongest motivators were the enjoyability of HTPs (55.73%) and usage as a cigarette alternative (54.64%), while the strongest deterrents were the negative health effects (82.68%) and potential for addiction (81.01%).

Conclusion

Our study underscores the need for awareness campaigns and interventions concerning HTPs, given prevalent preconceived notions and mixed attitudes among respondents. It was found that women and households with higher incomes scored higher on knowledge. Subjective enjoyment and a substitute for cigarettes were important motivators, but the most mentioned deterrents were the possibility of addiction and the detrimental effects on health. These insights form the basis for informed policy making for non-cigarette tobacco products.
Factors associated with clinical nurse’s mental health: a qualitative study applying the social ecological model
Authors: Yu Qiang , Huang Chongmei , Tian Yusheng , Yang Jiaxin , Li Xuting , Ning Meng , Chen Zengyu , Du Jie , He Jiaqing , Li Yamin
Published: May 2024

Background

The prevalence of burnout, depression, and anxiety among Chinese nurses was 34%, 55.5%, and 41.8% respectively. Mental health problems have significant impacts on their personal well-being, work performance, patient care quality, and the overall healthcare system. Mental health is influenced by factors at multiple levels and their interactions.

Methods

This was a descriptive qualitative study using phenomenological approach. We recruited a total of 48 nurses from a tertiary hospital in Changsha, Hunan Province, China. Data were collected through focus group interviews. Audio-recorded data were transcribed and inductively analysed.

Results

Four major themes with 13 subthemes were identified according to the social ecological model: (1) individual-level factors, including personality traits, sleep quality, workplace adaptability, and years of work experience; (2) interpersonal-level factors, encompassing interpersonal support and role conflict; (3) organization-level factors, such as organizational climate, organizational support, career plateau, and job control; and (4) social-level factors, which included compensation packages, social status, and legislative provision and policy.

Conclusions

Our study provides a nuanced understanding of the multifaceted factors influencing nurses’ mental health. Recognizing the interconnectedness of individual, interpersonal, organizational, and social elements is essential for developing targeted interventions and comprehensive strategies to promote and safeguard the mental well-being of nurses in clinical settings.

Trial and protocol registration

The larger study was registered with Chinese Clinical Trial Registry: ChiCTR2300072142 (05/06/2023) https://www.chictr.org.cn/showproj.html?proj=192676.

Reporting method

This study is reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ).
Potent drug delivery enhancement of betulinic acid and NVX-207 into equine skin in vitro – a comparison between a novel oxygen flow-assisted transdermal application device and microemulsion gels
Authors: Zscherpe Paula , Kalbitz Jutta , Weber Lisa A. , Paschke Reinhard , Mäder Karsten , von Rechenberg Brigitte , Cavalleri Jessika-M. V. , Meißner Jessica , Klein Karina
Published: May 2024

Background

Gray horses are predisposed to equine malignant melanoma (EMM) with advancing age. Depending on the tumor’s location and size, they can cause severe problems (e.g., defaecation, urination, feeding). A feasible therapy for EMM has not yet been established and surgical excision can be difficult depending on the location of the melanoma. Thus, an effective and safe therapy is needed. Naturally occurring betulinic acid (BA), a pentacyclic triterpene and its synthetic derivate, NVX-207 (3-acetyl-betulinic acid-2-amino-3-hydroxy-2-hydroxymethyl-propanoate) are known for their cytotoxic properties against melanomas and other tumors and have already shown good safety and tolerability in vivo. In this study, BA and NVX-207 were tested for their permeation potential into equine skin in vitro in Franz-type diffusion cell (FDC) experiments after incubation of 5 min, 30 min and 24 h, aiming to use these formulations for prospective in vivo studies as a treatment for early melanoma stages. Potent permeation was defined as reaching or exceeding the half maximal inhibitory concentrations (IC50) of BA or NVX-207 for equine melanoma cells in equine skin samples. The active ingredients were either dissolved in a microemulsion (ME) or in a microemulsion gel (MEG). All of the formulations were transdermally applied but the oil-in-water microemulsion was administered with a novel oxygen flow-assisted (OFA) applicator (DERMADROP TDA).

Results

All tested formulations exceeded the IC50 values for equine melanoma cells for BA and NVX-207 in equine skin samples, independently of the incubation time NVX-207 applied with the OFA applicator showed a significant time-dependent accumulation and depot-effect in the skin after 30 min and 24 h (P < 0.05).

Conclusions

All tested substances showed promising results. Additionally, OFA administration showed a significant accumulation of NVX-207 after 30 min and 24 h of incubation. Further in vivo trials with OFA application are recommended.
Exposure to hyperbaric O2 levels leads to blood-brain barrier breakdown in rodents
Authors: Danino Yehuda M. , Rabinovitz Ricarina , Kirshenboim Inbar , Palzur Eilam , Pick Chaim G. , Ish-Shalom Itamar , Golovkin Yana , Arieli Yehuda
Published: May 2024

Introduction

Hyperbaric oxygen has been used as a medical treatment tool in hyperbaric chambers and is an integral part of professional and combat divers’ activity. In extreme cases, exposure to hyperbaric oxygen can develop central nervous system oxygen toxicity (CNS-OT), which leads to seizures and eventually death. CNS-OT is caused by neuronal hyperactivity due to high oxygen levels, potentially damaging brain cells including the blood-brain barrier (BBB). However, the effect of hyperbaric oxygen levels on the healthy BBB has not been characterized directly yet.

Methods

Six or three different groups of ~ eight rats or mice, respectively, were exposed to increasing levels of partial pressure of oxygen (0.21 to 5 ATA) in a hyperbaric chamber, followed by MRI scanning with gadolinium. Statistical significance (adjusted p-value ≤ 0.05) was assessed using linear regression and ordinary one-way (rats) or two-way (mice) ANOVA with correction of multiple comparison tests. In rats, the effect of 100% oxygen at 5 ATA was independently validated using FITC-Dextran (5 kDa). Statistical significance (p-value ≤ 0.05) was assessed using Welch’s t-test and effect size was calculated by Cohen’s D.

Results

In rats, analyzed MRI scans showed a significant trend of increase in the % gadolinium in brain tissues as a result of hyperbaric oxygen pressures (p-value = 0.0079). The most significant increase was measured at 4 ATA compared to air (adjusted p-value = 0.0461). Significant increased FITC-Dextran levels were measured in the rats’ brains under 100% oxygen at 5 ATA versus air (p-value = 0.0327; Effect size = 2.0). In mice, a significant increase in gadolinium penetration into the hippocampus and frontal cortex was measured over time (adjusted p-value < 0.05) under 100% oxygen at 3 and 5 ATA versus air, and between the treatments (adjusted p-value < 0.0001).

Conclusions

The BBB is increasingly disrupted due to higher levels of hyperbaric oxygen in rodents, indicating a direct relation between hyperbaric oxygen and BBB dysregulation for the first time. We suggest considering this risk in different diving activities, and protocols using a hyperbaric chamber. On the other hand, this study highlights the potential therapeutic usage of hyperbaric oxygen for controlled drug delivery through the BBB into brain tissues in different brain-related diseases.
Robot-assisted thoracoscopic resection of a posterior mediastinal tumor with immunoglobulin G4-related disease: a case report
Authors: Takeuchi Taihei , Takizawa Hiromitsu , Bando Yoshimi , Hosokawa Akio , Sumitomo Hiroyuki , Miyamoto Naoki , Sakamoto Shinichi , Morishita Atsushi , Kawakita Naoya , Toba Hiroaki
Published: May 2024

Background

Immunoglobulin (Ig)G4-related disease affects nearly every organ, and its clinical course varies depending on the involved organ; however, its occurrence in the mediastinum is rarely reported.

Case presentation

A 58-year-old woman presented with a posterior mediastinal tumor along the thoracic spine on imaging. Based on her elevated serum IgG4 level of 349.7 mg/dL, IgG4-related disease was suspected. Since the tumor was growing and malignancy could not be excluded, surgical resection was performed for definitive diagnosis. Robot-assisted thoracoscopic surgery was performed via the left semipronation and right thoracic approaches. The irregularly-shaped tumor was located on the level of the seventh to ninth thoracic vertebra, along the sympathetic nerve. A malignancy was not excluded based on the appearance of the tumor. The tumor had poor mobility. The sympathetic nerves, intercostal arteries, and veins were also excised. In this case, the articulated forceps, used during the robotic surgery, were useful in achieving complete tumor resection along the vertebral body. The pathological examination revealed IgG4-positive plasma infiltration, which fulfilled the criteria for IgG4-related diseases. The postoperative course was uneventful, and the patient underwent follow-up on an outpatient basis without additional medications.

Conclusion

The clinical presentation of IgG4-related disease varies, based on the involved organs. This case was rare because the mediastinum was involved, and it emphasized the effectiveness of surgical resection.
Effect of radiation therapy on lymph node fluorescence in head and neck squamous cell carcinoma after intravenous injection of indocyanine green: a prospective evaluation
Authors: Digonnet Antoine , Vankerkhove Sophie , Moreau Michel , Dekeyser Cécile , Quiriny Marie , Willemse Esther , de saint Aubain Nicolas , Cappello Matteo , Donckier Vincent , Bourgeois Pierre
Published: May 2024

Background

Indocyanine green (ICG)-guided surgery has proven effective in the identification of neoplastic tissues. The effect of radiation therapy (RT) on lymph node fluorescence after intravenous injection of ICG has not been addressed yet. The objective of this study was to evaluate the influence of RT on node fluorescence during neck dissection in head and neck squamous cell carcinoma (HNSCC).

Results

Twenty-four patients with planned neck dissection for HNSCC were prospectively enrolled. Eleven were included without previous radiation therapy and 13 after RT. ICG was intravenously administered in the operating room. The resected specimen was analyzed by the pathology department to determine the status of each resected lymph node (invaded or not). The fluorescence of each resected node was measured in arbitrary units (AU) on paraffin blocs. The surface area (mm2) of all metastatic nodes and of the invaded component were measured. The values of these surface areas were correlated to fluorescence values. A total of 707 nodes were harvested, the mean fluorescence of irradiated nodes (n = 253) was 9.2 AU and of non-irradiated nodes (n = 454) was 9.6 AU (p = 0.63). Fifty nodes were invaded, with a mean fluorescence of 22 AU. The mean fluorescence values in the invaded irradiated nodes (n = 20) and the invaded non-irradiated nodes (n = 30) were 19 AU and 28 AU (p = 0.23), respectively. The surface area of metastatic nodes and of the invaded component were correlated to fluorescence values even after previous RT (p = 0.02).

Conclusion

No differences were observed between the fluorescence of irradiated and non-irradiated lymph nodes, including invaded nodes. ICG-guided surgery can be performed after failed RT.

Trial registration

EudraCT ref. 2013-004498-29, registered 29 November 2013. https://www.clinicaltrialsregister.eu/ctr-search/search?query=2013-004498-29
The prevalence of post traumatic and associated factors among nurses during COVID_19 pandemics: a systematic review and meta-analysis
Authors: Karbasi Afsaneh , Babakhanian Masoudeh , Ahmadzadeh Akram , Omranifard Victoria
Published: May 2024

Background

Despite the negative outcomes, exposure to a crisis may cause people to experience positive changes. This study aims to analyze the prevalence of post-traumatic growth (PTG) and its relevant factors among nurses during the COVID-19 pandemic.

Method

The research protocol was registered with PROSPERO (CRD42022329671), and PRISMA steps were taken in this study. PubMed, Scopus and ProQuest were explored on 1/9/2022 to create the research database. According to the inclusion criterion, all studies analyzing the prevalence of post-traumatic growth through the PTG Inventory were considered eligible. They were all qualitatively assessed through the modified version of the Quality Assessment Checklist for prevalence studies.

Results

A total of 15 papers met the inclusion criterion (n = 22756). According to the research results, the prevalence of PTG was randomly calculated ES [95% Conf. Interval = 0.15 [0.12–0.17]), and heterogeneity was reported I2 = 98.52% (P = 0.000). The results also indicated that the mean score of PTGI decreased in nurses as their work experience and mean age increased. However, the effect was not statistically significant for the mean age (P = 0.06). According to the results, the PTGI score decreased in nurses with more work experience, a finding which was statistically significant (P = 0.04).

Conclusion

This meta-analysis determined a 15% prevalence rate of PTG in nurses. Psychological interventions should be developed and applied to older nurses with more work experience in order to mitigate the harm caused by the pandemic and its consequent crises.
The Clinical Utility of a Tiered Approach to Pediatric Glioma Molecular Characterization for Resource-Limited Settings
Authors: Hammad Rawan , Nobre Liana , Ryall Scott , Arnoldo Anthony , Siddaway Robert , Bennett Julie , Tabori Uri , Hawkins Cynthia
Published: May 2024

PURPOSE

Molecular characterization is key to optimally diagnose and manage cancer. The complexity and cost of routine genomic analysis have unfortunately limited its use and denied many patients access to precision medicine. A possible solution is to rationalize use—creating a tiered approach to testing which uses inexpensive techniques for most patients and limits expensive testing to patients with the highest needs. Here, we tested the utility of this approach to molecularly characterize pediatric glioma in a cost- and time-sensitive manner.

METHODS

We used a tiered testing pipeline of immunohistochemistry (IHC), customized fusion panels or fluorescence in situ hybridization (FISH), and targeted RNA sequencing in pediatric gliomas. Two distinct diagnostic algorithms were used for low- and high-grade gliomas (LGGs and HGGs). The percentage of driver alterations identified, associated testing costs, and turnaround time (TAT) are reported.

RESULTS

The tiered approach successfully characterized 96% (95 of 99) of gliomas. For 82 LGGs, IHC, targeted fusion panel or FISH, and targeted RNA sequencing solved 35% (29 of 82), 29% (24 of 82), and 30% (25 of 82) of cases, respectively. A total of 64% (53 of 82) of samples were characterized without targeted RNA sequencing. Of 17 HGG samples, 13 were characterized by IHC and four were characterized by targeted RNA sequencing. The average cost per sample was more affordable when using the tiered approach as compared with up-front targeted RNA sequencing in LGG ($405 US dollars [USD] v $745 USD) and HGGs ($282 USD v $745 USD). The average TAT per sample was also shorter using the tiered approach (10 days for LGG, 5 days for HGG v 14 days for targeted RNA sequencing).

CONCLUSION

Our tiered approach molecularly characterized 96% of samples in a cost- and time-sensitive manner. Such an approach may be feasible in neuro-oncology centers worldwide, particularly in resource-limited settings.
Real-World Impact of Comprehensive Genomic Profiling on Biomarker Detection, Receipt of Therapy, and Clinical Outcomes in Advanced Non–Small Cell Lung Cancer
Authors: Wallenta Law Jeanna , Bapat Bela , Sweetnam Connor , Mohammed Hina , McBratney Ashleigh , Izano Monika A. , Scannell Bryan Molly , Spencer Scott , Schroeder Brock , Hostin Damon , Simon George R. , Berry Anna B.
Published: May 2024

PURPOSE

Therapeutic decision making for patients with advanced non–small cell lung cancer (aNSCLC) includes a growing number of options for genomic, biomarker-guided, targeted therapies. We compared actionable biomarker detection, targeted therapy receipt, and real-world overall survival (rwOS) in patients with aNSCLC tested with comprehensive genomic profiling (CGP) versus small panel testing (SP) in real-world community health systems.

METHODS

Patients older than 18 years diagnosed with aNSCLC between January 1, 2015, and December 31, 2020, who received biomarker testing were followed until death or study end (September 30, 2021), and categorized by most comprehensive testing during follow-up: SP (≤52 genes) or CGP (>52 genes).

RESULTS

Among 3,884 patients (median age, 68 years; 50% female; 73% non-Hispanic White), 20% received CGP and 80% SP. The proportion of patients with ≥one actionable biomarker (actionability) was significantly higher in CGP than in SP (32% v 14%; P < .001). Of patients with actionability, 43% (CGP) and 38% (SP) received matched therapies ( P = .20). Among treated patients, CGP before first-line treatment was associated with higher likelihood of matched therapy in any line (odds ratio, 3.2 [95% CI, 1.84 to 5.53]). CGP testing (hazard ratio [HR], 0.80 [95% CI, 0.72 to 0.89]) and actionability (HR, 0.84 [95% CI, 0.77 to 0.91]) were associated with reduced risk of mortality. Among treated patients with actionability, matched therapy receipt showed improved median rwOS in months in CGP (34 [95% CI, 21 to 49] matched v 14 [95% CI, 10 to 18] unmatched) and SP (27 [95% CI, 21 to 43] matched v 10 [95% CI, 8 to 14] unmatched).

CONCLUSION

Patients who received CGP had improved detection of actionable biomarkers and greater use of matched therapies, both of which were associated with significant increases in survival.
Endoluminal Sigmoid Sinus Occlusion During Jugular Foramen Tumor Surgery: Novel Technique, Operative Nuances, and Clinical Experience With 33 Patients
Authors: Castillo Andrea L. , Tang Oliver Y. , Gad Steve N. , Park Richard Chan Woo , Ying Yu-Lan Mary , Jyung Robert W. , Liu James K.
Published: May 2024

BACKGROUND AND IMPORTANCE:

Surgery of jugular foramen tumors (JFTs) often requires vascular control by means of ligating the internal jugular vein and sigmoid sinus (SS) to allow intrabulbar access. Occlusion of the SS traditionally involves presigmoid and retrosigmoid durotomies allowing introduction of ligature devices, predisposing to cerebrospinal fluid (CSF) leakage and pseudomeningoceles. We describe a simple and novel endoluminal sigmoid sinus occlusion (ESSO) technique with Gelfoam that is entirely extradural.

CLINICAL PRESENTATION:

An extended anterolateral infralabyrinthine approach with ESSO was performed in 33 patients with JFTs. After ligating the internal jugular vein, the SS is opened and Gelfoam is placed endoluminally into the proximal SS. Care is taken to avoid occlusion of the venous outflow of the vein of Labbe to avoid temporal lobe venous infarction. Hemostatic gelatin matrix is injected distally to stop venous backflow from the inferior petrosal sinus. The jugular venous system is isolated, and the outer jugular wall can be opened to expose the JFT for resection. There were no complications of temporal lobe venous infarction or postoperative hematoma observed. Four patients with intradural tumor extension developed pseudomeningoceles. For patients with purely extradural JFTs, none developed postoperative incisional CSF leaks and one had pseudomeningocele.

CONCLUSION:

This ESSO technique is fast and effective, permitting occlusion of the SS during JFT surgery. It has the advantage of being entirely extradural, avoiding durotomy which can result in postoperative CSF leak. It is important to keep the Gelfoam distal to the transverse-sigmoid junction to avoid occlusion of the vein of Labbe inlet and temporal lobe venous infarction.
La mancha urbana en Colombia sigue expandiéndose
Authors: Carriazo Osorio Fernando , López Plazas María Alejandra
Published: May 2024

Un estudio adelantado por un grupo interdisciplinar de investigadores, convocado por Fedesarrollo, revela detalles de cómo se ha producido el crecimiento de las ciudades colombianas en los últimos 30 años. Aunque crecen menos rápido que las del resto del mundo, su progreso no se ha dado siempre bajo los lineamientos del ordenamiento territorial.
Step 1 for the treatment of periodontal diseases
Authors: Keh Angeline , Yonel Zehra
Published: May 2024

The association between periodontitis and the dysbiotic biofilm necessitates that patients maintain excellent oral hygiene. Therefore, step 1 of the UK clinical practice guidelines for the treatment of periodontal diseases is aimed at behaviour change and motivation in successful removal of the supragingival dental biofilm and risk-factor control, which involves all the health behavioural change interventions that mitigate recognized risk factors for periodontitis onset and progression (smoking cessation, diabetes management). Step 1 should be tailored for the patient throughout the treatment journey and jointly with clinical findings and medical history.

CPD/Clinical Relevance: Step 1 lays the groundwork when progressing through ensuing steps of treatment and can affect response to any periodontal therapy.
Step 2 for the treatment of periodontal diseases
Authors: Shemie Melissa , Shah Mira , Dunn Ian
Published: May 2024

This article discusses the modalities of treatment involved in step 2 of periodontal therapy, including exploring looking at the evidence-based recommendations produced by the S3 stages I–III periodontal treatment guideline.

CPD/Clinical Relevance: Step 2 of periodontal therapy is essential for removal of the subgingival biofilm and reduction in the bacterial load.
Step 3 for the treatment of periodontal diseases: surgical regeneration of the periodontium
Authors: Raindi Devan S , Parmar Jay , Chapple Iain
Published: May 2024

Surgical regeneration can offer significant benefits in the management of teeth affected by severe periodontitis that continue to demonstrate pocketing following steps 1 and 2 of periodontal therapy. To gain the maximum benefit from this treatment modality, an understanding of the biological principles of regeneration, appropriate case selection and the latest surgical techniques are required. The most recent S3-level guideline released by the European Federation of Periodontology (EFP) and adoloped by the British Society of Periodontology is evidence based, and can support the clinician in such decision-making.

CPD/Clinical Relevance: Surgical regenerative techniques can play an important role in the treatment of complex periodontal defects.