bluuebunny/crossref_metadata_2025 huggingface dataset:
MiR-337 suppresses pancreatic cancer development via STAT3/Wnt/β-catenin axis
Authors: Shi Jin , Su Qingliang , Han Fei , Chen Wenping , Zhang Donghua , Xu Baoli
Published: February 2021

MiRNA is an important regulator of tumorigenesis and tumor progression. MiR-337 expression was increased in pancreatic cancer tissues and it was associated with patients’ survival. This study aimed to explore the influence and the potential working mechanism of miR-337 on the malignant behaviors of pancreatic cancer cells. MiR-337 expression was detected by qRT-PCR. The expression levels of STAT3, epithelial-mesenchymal transition–related genes and Wnt/β-Catenin pathway genes were evaluated by qRT-PCR and western blot. Cell counting kit -8 and colony formation assays were conducted to examine the proliferation of AsPC-1 and SW1990 cells. Wound healing and transwell assays were performed to determine the migration and invasion of AsPC-1 and SW1990 cells. The predicted target gene of miR-337 was verified by luciferase reporter assay. The expression of miR-337 was decreased and STAT3 expression was increased in pancreatic cancer tissues as well as tumor cells. Overexpression of miR-337 suppressed proliferation, invasion and migration of AsPC-1 and SW1990 cells. MiR-337 targeted 3′UTR of STAT3 and inhibited STAT3 expression. In addition, exogenous STAT3 partially restored the inhibitory role of miR-337 on proliferation, invasion and migration of AsPC-1 and SW1990 cells. Moreover, miR-337 impeded the expression of Wnt/β-catenin pathway-related genes. Through the saving experiment, we found that the inhibitory effect of miR-337 on AsPC-1 and SW1990 cells was abolished by the addition of LiCl. These outcomes expounded that miR-337 inactivated the Wnt/β-catenin pathway to suppress the malignant behaviors of pancreatic cancer cells through targeting STAT3. This study may provide a novel biomarker for diagnosis and a new therapeutic target for pancreatic cancer treatment.
High-Flow Oxygen Therapy Application in Chronic Obstructive Pulmonary Disease Patients With Acute Hypercapnic Respiratory Failure: A Multicenter Study
Authors: Plotnikow Gustavo A. , Accoce Matias , Fredes Sebastián , Tiribelli Norberto , Setten Mariano , Dorado Javier , Guaymas Maria , Ilutovich Santiago , Rodriguez Pablo O. , Cesio Cristian E. , Scapellato Jose L. , Vasquez Daniela N.
Published: February 2021

Objectives:

To evaluate the effect of high-flow oxygen implementation on the respiratory rate as a first-line ventilation support in chronic obstructive pulmonary disease patients with acute hypercapnic respiratory failure.

Design:

Multicenter, prospective, analytic observational case series study.

Setting:

Five ICUs in Argentina, between August 2018 and September 2019.

Patients:

Patients greater than or equal to 18 years old with moderate to very severe chronic obstructive pulmonary disease, who had been admitted to the ICU with a diagnosis of hypercapnic acute respiratory failure, were entered in the study.

Interventions:

High-flow oxygen therapy through nasal cannula delivered using high-velocity nasal insufflation.

Measurements and Main Results:

Forty patients were studied, 62.5% severe chronic obstructive pulmonary disease. After the first hour of high-flow nasal cannula implementation, there was a significant decrease of respiratory rate compared with baseline values, with a 27% decline (29 vs 21 breaths/min; p < 0.001). Furthermore, a significant reduction of Paco
2 (57 vs 52 mm Hg [7.6 vs 6.9 kPa]; p < 0.001) was observed. The high-flow nasal cannula application failed in 18% patients. In this group, the respiratory rate, pH, and Paco
2 showed no significant change during the first hour in these patients.

Conclusions:

High-flow oxygen therapy through nasal cannula delivered using high-velocity nasal insufflation was an effective tool for reducing respiratory rate in these chronic obstructive pulmonary disease patients with acute hypercapnic respiratory failure. Early determination and subsequent monitoring of clinical and blood gas parameters may help predict the outcome.
Chronic Itch of Unknown Origin Is Associated With an Enhanced Th2 Skin Immune Profile
Authors: Dehner Carina , Chen Lu , Kim Brian , Rosman Ilana S.
Published: February 2021

Chronic pruritus of unknown origin (CPUO) is described as chronic itch lasting longer than 6 weeks in the absence of a defined skin rash and any known causative disease process. A retrospective study was performed on biopsy samples from patients with CPUO and normal controls to compare the immune profiles of these patients with healthy individuals. We used dual CD3/T-bet and CD3/GATA3 immunohistochemical staining to assess for T-cells expressing Th1 versus Th2 transcription factors, respectively. Our data showed that CD3+ cells of patients with CPUO co-express significantly more GATA3 compared with normal controls. Meanwhile, the normal control skin showed a much more balanced T-bet/GATA3 ratio of co-expression. Our data suggest an enrichment of Th2 cells in CPUO skin by T cell/GATA3 co-staining, supporting that CPUO is increasingly considered a type 2/Th2 cell-associated disease. We thus speculate that type 2 cytokine blockade-based therapies may represent effective treatments for CPUO.
Digital Myxoid Cysts: Correlation of Initial and Long-Term Response to Steroid Injections
Authors: Sechi Andrea , Starace Michela , Alessandrini Aurora , Caposiena Caro Raffaele Dante , Piraccini Bianca Maria
Published: February 2021

BACKGROUND

Digital mucous cysts (DMCs) are benign myxoid pseudocysts that develop on the distal interphalangeal joint's lateral or dorsal aspects. Management consists either of a surgical approach, conservative therapy, or simple follow-up.

OBJECTIVE

To correlate the initial and long-term response with clinical and ultrasound parameters in DMCs treated with intralesional steroids as first-line therapy.

METHODS

A single-center prospective open-label study recruited 15 patients affected by DMCs, who had been treated with a cycle of up to 3 steroid injections at a 6 to 9 week time interval.

RESULTS

At the first follow-up visit, 53.3% of patients were cleared of DMCs, achieving a complete response, whereas 46.7% experienced a >30% decrease in their DMC volume, and were considered partial responders. After 1 year of follow-up, the cure rate decreased to 40%, and the recrudescence rate was 27.3%. Clinical and sonographic characteristics that positively correlated with a maintained complete response at follow-up were as follows: young age, absence of osteophytes, low volume, complete clearance at T1, and short disease duration (p < .05).

CONCLUSION

Intralesional steroid therapy is an easy approach for DMC, with minimal side effects; identifying predictive hallmarks is useful to offer a straightforward surgical treatment to patients who have nonresponder characteristics.
Discriminative stimulus effects of 3,4-methylenedioxypyrovalerone (MDPV) and structurally related synthetic cathinones
Authors: Seaman Robert W. , Doyle Michelle R. , Sulima Agnieszka , Rice Kenner C. , Collins Gregory T.
Published: February 2021

The 3,4-methylenedioxypyrovalerone (MDPV), and other structurally related synthetic cathinones, are popular alternatives to prototypical illicit psychostimulants, such as cocaine and methamphetamine. These drugs are often referred to as ‘bath salts’ and function either as cocaine-like inhibitors of monoamine uptake, or amphetamine-like substrates for dopamine, norepinephrine and serotonin transporters. These studies used male Sprague–Dawley rats trained to discriminate MDPV from saline to evaluate the substitution profiles of structurally related synthetic cathinones, cocaine, and other direct-acting dopamine and noradrenergic receptor agonists in order to characterize the relative contributions of dopamine, norepinephrine and serotonin to the discriminative stimulus effects of MDPV. As expected, each of the cathinones and cocaine dose-dependently increased MDPV-appropriate responding, with a rank-order potency that was positively correlated with their potency to inhibit dopamine and norepinephrine, but not serotonin, a relationship that is consistent with the rank order to maintain self-administration. The dopamine D2/3 receptor-preferring agonist quinpirole produced a modest increase in MDPV-appropriate responding, whereas the dopamine D1/5 receptor agonist, SKF 82958, nonselective dopamine receptor agonist, apomorphine, as well as the α–1, and α–2 adrenergic receptor agonists, phenylephrine and clonidine, respectively, failed to increase MDPV-appropriate responding at doses smaller than those that suppressed responding altogether. Although these studies do not support a role for serotonergic or adrenergic systems in mediating/modulating the discriminative stimulus effects of MDPV, convergent evidence is provided to suggest that the discriminative stimulus effects of MDPV are primarily mediated by its capacity to inhibit dopamine uptake, and the subsequent activation of dopamine D2 or D3 receptors.
Longitudinal associations of blood pressure with aortic stiffness and pulsatility: the Atherosclerosis Risk in Communities Study
Authors: Metcalf Patricia A. , Meyer Michelle L. , Tanaka Hirofumi , Agarwal Sunil K. , Windham B. Gwen , Cheng Susan , Couper David , Folsom Aaron R. , Heiss Gerardo
Published: February 2021

Objective:

To characterize the longitudinal relationships between blood pressure measured over 24 years and arterial stiffness in late life measured as pulse wave velocity (PWV).

Methods:

Carotid--femoral (cf) and femoral--ankle (fa) PWV were measured in 4166 adults at the visit 5 Atherosclerosis Risk in Communities study cohort examination (2011–2013). Participants were categorized into tertiles of PWV measurements. Blood pressure measurements were made at baseline (1987–1989), three subsequent triennial examinations, and visit 5.

Results:

Partial correlation coefficients between visit 5 cfPWV and SBP ranged from 0.13 for visit 1 SBP to 0.32 for visit 5 SBP. For visit 5 faPWV, correlations were ∼0 for visits 1 to 4 SBP, but was 0.20 for visit 5 SBP. Over 24 years of follow-up, those with higher average SBP were more likely to fall in the middle and upper tertiles of visit 5 cfPWV. Average pulse pressure and mean arterial pressure over 24 years had similar but weaker associations with cfPWV tertiles. DBP had no clear association with cfPWV. Blood pressure measurements were positively associated with faPWV tertiles only cross-sectionally at visit 5.

Conclusion:

Adult life-course measures of SBP, more so than mean arterial and pulse pressure, were associated with later life central arterial stiffness. By contrast, only contemporaneous measures of blood pressure were associated with peripheral arterial stiffness. Although arterial stiffness was only measured at later life, these results are consistent with the notion that elevated blood pressure over time is involved in the pathogenesis of arterial stiffening.
DTPA Treatment of Wound Contamination in Rats with Americium: Evaluation of Urinary Profiles Using STATBIODIS Shows Importance of Prompt Administration
Authors: Lamart Stephanie , Van der Meeren Anne , Coudert Sylvie , Baglan Nicolas , Griffiths Nina M.
Published: February 2021

In the nuclear industry, wound contamination with americium is expected to increase with decommissioning and waste management. Treatment of workers with diethylenetriaminepentaacetic acid (DTPA) requires optimization to reduce internal contamination and radiation exposure. This work aimed at evaluating and comparing different DTPA protocol efficacies after wound contamination of rats with americium. Wound contamination was simulated in rats by depositing americium nitrate in an incision in the hind limb. Different routes, times, and frequencies of DTPA administration were evaluated. Individual daily urinary americium excretion and tissue retention were analyzed using the statistical tool STATBIODIS. Urinary profiles, urinary enhancement factors, and inhibition percentages of tissue retention were calculated. A single DTPA administration the day of contamination induced a rapid increase in americium urinary excretion that decreased exponentially over 7 d, indicating that the first DTPA administration should be delivered as early as possible. DTPA treatment limited americium uptake in systemic tissues irrespective of the protocol. Liver and skeleton burdens were markedly reduced, which would drive reduction of radiation dose. Local or intravenous injections were equally effective. Inherent difficulties in wound site activity measurements did not allow identification of a significant decorporating effect at the wound site. Repeated intravenous injections of DTPA also increased americium urinary excretion, which supports the use of multiple DTPA administrations shortly after wound contamination. Results from these statistical analyses will contribute to a better understanding of americium behavior in the presence or absence of DTPA and may aid optimization of treatment for workers.
Outcomes of first 50 cases using a new pupil expander
Authors: Sheen-Ophir Shira , Wong John , Assia Ehud I.
Published: February 2021

Purpose:

To describe the initial experience with the Assia Pupil Expander 200 (APX-200, APX Ophthalmology) in eyes that underwent phacoemulsification or intraocular lens repositioning surgery that required mechanical pupil expansion.

Setting:

Department of Ophthalmology, Meir Medical Center, Kfar-Saba, and Ein-Tal Eye Center, Tel Aviv, Israel.

Design:

Retrospective case series.

Methods:

The APX-200 is a single-use device, intended for mechanical expansion of the pupil during intraocular surgery. Two devices are inserted through 2 opposite 19-gauge incisions using designated forceps. The surgical course and early postoperative follow-up was recorded in 50 eyes.

Results:

The study included 50 consecutive eyes, with mean preoperative pupil diameter was 3.7 mm. The APX effectively dilated the pupils in all cases. No complication related to the use of the APX such as hyphema, iridodialysis, or Descemet membrane detachment were noted in this series. A central and round pupil was restored in all eyes at 1-month postoperatively, with 14 eyes (28%) having mild sphincter tears. Pupilloplasty was not required in any of the cases.

Conclusions:

The APX-200 was an effective and safe device for pupil expansion during intraocular surgery.
Comparison of refractive outcomes after combined cataract and glaucoma surgery: trabeculectomy and glaucoma drainage device implantation
Authors: Asano Shotaro , Koh Teck Chang Victor , Aquino Maria Cecilia , Lim Ka-Ann Dawn , Sng Chelvin Cheryl Anges , Loon Seng Chee , Chew Tec Kuan Paul
Published: February 2021

Purpose:

To investigate the refractive outcome of combined cataract surgery and glaucoma drainage device (GDD) implantation compared with trabeculectomy and cataract surgery.

Setting:

Department of Ophthalmology, National University Health System, Singapore.

Design:

Retrospective cohort study.

Methods:

206 eyes were enrolled for analysis: 50 had combined cataract surgery and trabeculectomy (trabeculectomy group), 50 had combined cataract surgery and GDD implantation (GDD group), and 106 had cataract surgery alone (control group). Refractive prediction error and absolute prediction error of each glaucoma surgery group were compared with the control group. Subgroup analysis was performed in the following axial length (AL) subgroups: short (<22.5 mm), medium (≥22.5 to <25.5 mm), and long (≥25.5 mm).

Results:

In total, 206 eyes were examined. There was no statistically significant difference in the overall refractive prediction error between the GDD (0.00 ± 0.54 diopters [D]) and the control group (0.10 ± 0.53 D, P = .58). There was significant myopic refractive prediction error in the trabeculectomy group (−0.18 ± 0.88 D, P = .020). In eyes with short AL, a greater absolute prediction error was observed in the GDD group (−0.75 ± 0.43 D, P = .039).

Conclusions:

Apart from a significant deviation in short AL eyes, combined cataract surgery and GDD implantation demonstrated no significant postoperative refractive prediction error.
Impact of correlation of angle α with ocular biometry variables
Authors: Velasco-Barona Cecilio , Corredor-Ortega Claudia , Avendaño-Domínguez Argelia , Cervantes-Coste Guadalupe , Cantú-Treviño Mara P. , Gonzalez-Salinas Roberto
Published: February 2021

Purpose:

To analyze the association between angle α and ocular biometry in the general population at a third-level ophthalmology hospital.

Setting:

Anterior Segment Surgery Department, Asociación para Evitar la Ceguera en México I.A.P., Mexico City, Mexico.

Design:

Prospective, cross-sectional study.

Methods:

Healthy subjects who attended the hospital for a comprehensive ophthalmological evaluation were examined, and general data were collected. A complete ophthalmological assessment and biomicroscopy evaluation were performed and biometry and clinical data were obtained, including visual acuity, axial length (AL), keratometry (K), white-to-white (WTW) measurement. An OPD-Scan III analyzer was used to assess both the angle α distance and biometry parameters.

Results:

74 eyes from the same number of patients were included; 43 (58.10%) were women. A statistically significant inverse correlation was found between the angle α and the AL (r = −0.585; P < .0001) and between the WTW distance and the mean K (r = 0.557; P < .0001). A significant correlation was found between the mean K and the angle α (r = 0.271; P = .019). A significant inverse correlation was observed regarding the WTW distance and angle α (r = −0.359; P = .001). By contrast, a direct correlation was evidenced between the WTW and the AL (r = 0.385; P = .0007).

Conclusions:

There was a significant inverse correlation between the AL and the angle α magnitude. Hyperopic patients demonstrated significantly higher angle α values when compared with those of myopic patients. In addition, hyperopic eyes with steeper mean K and lesser WTW distance were associated with an increased angle α.
Refractive and keratometric outcomes of supervised novice surgeon–performed limbal relaxing incisions: 1-year results
Authors: Riaz Kamran M. , Wang Li , Williams Blake , Dvorak Justin D. , Kloek Carolyn E. , Farooq Asim V. , Koch Douglas D.
Published: February 2021

Purpose:

To report refractive and keratometric astigmatism outcomes of resident-performed limbal relaxing incisions (LRIs) during cataract surgery.

Setting:

Tertiary care academic teaching hospital.

Design:

Retrospective case series.

Methods:

The length, location, and number of LRIs were determined preoperatively using an online calculator. Variables studied were preoperative keratometry and postoperative uncorrected and corrected distance visual acuity, refraction, and keratometry at 1-month, 3-month, and 12-month visits (POM1, POM3, and POM12, respectively). Subgroup analysis was performed on amount and type of astigmatism. The astigmatism double-angle plot tool and analysis of with-the-wound (WtW) and against-the-wound (AtW) changes were used to assess the effect of astigmatism correction at POM1, POM3, and POM12 visits.

Results:

In 118 eyes, a higher percentage of eyes demonstrated refractive astigmatism 0.25 diopter (D) or less, 0.50 D or less, 0.75D or less, and 1.0 D or less at POM1 and POM12 (all P < .05) compared with preoperative keratometric astigmatism. Subgroup analysis showed improvement in all groups and types of astigmatism (P < .01). Patients achieved a statistically significant reduction of keratometric astigmatism at POM1, POM3, and POM12 (all P ≤ .0001) relative to baseline, and changes differed significantly based on the preoperative amount of astigmatism (all P ≤ .0001, with greater reductions associated with higher baseline astigmatism) but not by location of the steep meridian. There were significant WtW-AtW changes at POM1, POM3, and POM12. Regression of effect after 1 month was approximately 0.11 D.

Conclusions:

Resident-performed LRIs achieved effective and sustained reduction of both refractive and keratometric astigmatism regardless of meridian or magnitude of astigmatism for at least 1 year postoperatively.
Adjustment of intraocular lens tilt during intrascleral fixation assisted by intraoperative OCT
Authors: Fukumoto Ryuki , Inoue Makoto , Ishida Tomoka , Koto Takashi , Hirakata Akito
Published: February 2021

Purpose:

To evaluate the efficacy of using intraoperative optical coherence tomography (iOCT) to adjust the tilting of an intraocular lens (IOL) during implantation with intrascleral fixation.

Setting:

Kyorin University Hospital, Tokyo, Japan.

Design:

Retrospective, case–control, single-center study.

Methods:

Thirty-seven eyes of 37 patients who had undergone pars plana vitrectomy with intrascleral fixation of an IOL by a single surgeon were retrospectively studied. The length of the externalized haptics was determined when the anterior surface of the IOL was parallel to the plane of the iris as observed by iOCT. The maximal IOL tilt relative to the visual axis and to the iris plane was measured by anterior segment OCT (CASIA2; Tomey Corp.).

Results:

Intraoperative crosssectional OCT (RESCAN 700: Carl Zeiss Meditec AG) scans were used to adjust the degree of IOL tilt in 23 eyes (iOCT group) and not used in 14 eyes (control group). The maximal angle of IOL tilt relative to the visual axis was significantly smaller in the iOCT group than that in the control group (5.45 ± 2.63 degrees vs 10.38 ± 10.48 degrees, P = .034). The maximal angle of the IOL tilt to the iris plane was also significantly smaller in the iOCT group than that in the control group (4.58 ± 1.86 degrees vs 9.60 ± 10.82 degrees; P = .040). The distance of decentration was greater in the iOCT group (0.56 ± 0.29 mm) than that of the control group (0.41 ± 0.41 mm, P = .005).

Conclusions:

Intraoperative OCT can be used to adjust the degree of IOL tilt to reduce the lenticular astigmatism during intrascleral fixation surgery.
Efficacy of Vortioxetine Monotherapy for Posttraumatic Stress Disorder
Authors: Dunlop Boadie W. , Rakofsky Jeffrey J. , Newport D. Jeffrey , Mletzko-Crowe Tanja , Barone Katelyn , Nemeroff Charles B. , Harvey Philip D.
Published: February 2021

Purpose/Background

There are few efficacious pharmacological treatments for posttraumatic stress disorder (PTSD) and many patients fail to benefit from existing treatments. Vortioxetine, a recently developed antidepressant, acts as a serotonin modulator through inhibition of the serotonin transporter and actions at multiple types of serotonin receptors. Its unique pharmacodynamic profile suggests it may have efficacy for the treatment of PTSD.

Methods/Procedures

We conducted a 12-week placebo-controlled, randomized clinical trial of vortioxetine (flexibly dosed from 10 to 20 mg/d) versus placebo in adults with PTSD. The primary outcome was change from baseline in the past-month version of the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), analyzed using a mixed-model repeated-measures analysis of variance.

Findings/Results

Forty-one patients were randomized, and 32 (78%) completed the 12 weeks of treatment. The mean reduction in CAPS-5 scores at week 12 did not significantly differ between the 2 arms; the effect size for the difference in changes between vortioxetine and placebo on CAPS-5 total scores at week 12 was Cohen d = 0.29. However, at week 8, the drug-placebo difference was d = 0.78, which met the multivariate criteria for statistical significance, P = 0.014.

Implications/Conclusions

In this study of 41 patients, vortioxetine did not demonstrate superiority over placebo for adults with PTSD. Future PTSD trials may benefit from stratifying the randomization based on number of years since the index traumatic event and a history of failure to respond to treatment.
Prevalence of Hormone-Related Cancers (HRCs) at Two-Time Points in Rural Saskatchewan
Authors: Khan Amal , Ahmed Shahid , Zaidi Adnan , Karunanayake Chandima , Dosman James A. , Pahwa Punam
Published: February 2021

Objective:

This study aimed to determine the prevalence of hormone-related cancers (HRCs) among Saskatchewan rural dwellers and explore associated risk factors.

Methods:

Data were analyzed from the Saskatchewan Rural Health Study (SRHS), which was a prospective cohort (2010 to 2014). Completed questionnaires were obtained from 4624 (2797) households, with information about 8261 (4867) individuals more than or equal to 18 years at baseline (follow-up). The crude prevalence of HRCs was calculated using appropriate formulae. Adjusted prevalence was calculated using logistic regression based on the generalized estimating equation (GEE).

Results:

Crude prevalence of HRCs was 3.0% at the baseline. Variables significantly associated with HRCs were: exposure to radiation comprising ultraviolet radiation from sunlight as well as ionizing radiation (odds ratio [OR] 3.39; 95% confidence interval [CI]: 2.23, 4.84), previous history of cancer in sibling (OR = 1.51, 95% CI: 1.11, 2.07) and in father (OR = 1.37; 95% CI = 1.01, 1.86).

Conclusions:

The study informs the Saskatchewan Health Region for health care resource allocation.
Vestibular Schwannoma Measurements—Is Volumetric Analysis Clinically Necessary?
Authors: Selleck Anne Morgan , Rodriguez Justin D. , Brown Kevin D.
Published: February 2021

Objective:

1) To compare vestibular schwannoma maximum linear dimensions and calculated volume with measured volume in accurately determining tumor volume and growth. 2) To determine natural growth history of vestibular schwannomas utilizing volumetric measurements in an observed patient population.

Study Design:

Retrospective chart review.

Setting:

Tertiary academic referral.

Patients:

One hundred fifty two adults with a vestibular schwannoma who underwent observational management with sequential magnetic resonance imaging (MRI) scans (496 scans).

Intervention:

MRI scans.

Main Outcome Measures:

Tumor volume calculated from linear dimensions compared with measured volume. The percentage change in tumor size (linear or volume) between consecutive MRI scans.

Results:

The percentage change in tumor size between consecutive MRIs is significantly different between maximum linear dimension (MLD) and measured tumor volume (p = 0.03), but no difference exists in the percentage change between measured and calculated tumor volume (p = 0.882 for three linear measurements, p = 0.637 for two linear measurements). The overall number of growing tumors is 57.2% (n = 87) with an average growth rate of 62.6%. If a criterion for growth of 20% change is used, 32.2% of tumors monitored by linear volume would have demonstrated growth while 57.2% of tumors with measured volume demonstrated growth.

Conclusion:

Maximum linear dimensions are a significantly less sensitive measure of tumor growth compared with measured volumes. Calculated tumor volume utilizing three linear measurements is an accurate predictor of both measured tumor volume and tumor growth.
Validation of Omron HEM-7600T, a wearable device for monitoring blood pressure, according to the American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization 81060-2:2013 protocol in the general population without arrhythmias
Authors: Takahashi Hakuo , Saito Kanako , Hishiki Yukiko
Published: February 2021

Objective

The present study aimed to evaluate the accuracy of the Omron HEM-7600T automated oscillometric upper-arm blood pressure (BP) monitor according to the American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization (ANSI/AAMI/ISO) 81060-2:2013 protocol.

Methods

We recruited individuals until we obtained 86 eligible participants whose BP levels and ranges of arm circumference met the BP distribution requirements specified by the ANSI/AAMI/ISO. In each individual, we sequentially measured systolic and diastolic blood pressures (DBPs) using a mercury sphygmomanometer (two observers) and the HEM-7600T device (one supervisor) in the left upper arm. Data analysis was performed according to the ANSI/AAMI/ISO guidelines.

Results

A total of 101 individuals were recruited, and 86 were finally included in the analysis. For validation criterion 1, the mean ± SD of the differences between the test device and reference BP was −0.6 ± 6.6/1.0 ± 6.5 mmHg (systolic/diastolic). The data were in accordance with criterion 1 of the ANSI/AAMI/ISO 81060-2:2013 standard requirements (≤ 5 ± ≤ 8 mmHg). In addition, the mean device-observer difference in the 86 participants was −0.6 ± 5.65 mmHg for systolic blood pressure and 1.0 ± 5.96 mmHg for DBP, fulfilling criterion 2 with an SD of ≤6.91 mmHg for systolic blood pressure and ≤6.87 mmHg for DBP.

Conclusion

The Omron HEM-7600T BP monitor fulfilled the requirements of the ANSI/AAMI/ISO validation protocol in adults and can be recommended for home BP measurements.
Utilisation and Safety of Polyethylene Glycol 3350 With Electrolytes in Children Under 2 Years
Authors: Roy Debabrata , Akriche Fatma , Amlani Bharat , Shakir Saad
Published: February 2021

Objectives:

In the UK, Movicol paediatric plain (polyethylene glycol 3350 with electrolytes [PEG 3350+E], Norgine, UK), is licensed for chronic constipation in children 2 –11 years of age and faecal impaction (FI) from 5 years. This study aimed to investigate usage and characterise the risk profile in children under 2 years of age using PEG 3350+E in the UK.

Methods:

Retrospective, single exposure cohort study, with patients identified from Clinical Practice Research Datalink (CPRD) GOLD. Patients first prescribed PEG 3350+E under 2 years of age for the treatment of constipation or FI, between September 2003 and July 2019, were included.

Results:

There were 13,235 patients with a constipation indication and 40 patients with FI. For the constipation cohort: median age of PEG 3350+E first prescription was 1.2 years [interquartile range (IQR) 0.9, 1.6] and 68.4% had one treatment episode (TE). The mean duration of exposure, in the first TE, was 88.9 days. The most common total daily dose was one sachet (6.9 g).

In terms of incident events on treatment, 0.5% of patients had abdominal pain, 3.0% had diarrhoea (may be attributed to treatment) and 4.1% had vomiting. 2.0% had signs/symptoms which could (in extreme cases) be associated with electrolyte disturbance, however, none had abnormal electrolyte values.

Discussion:

The safety aspect of this study did not identify any signals of concern in the constipation cohort. The number of patients in the FI cohort were too small for robust conclusions. If information were available, then a safety study would ideally assess treatment intake per kilogram, including electrolyte intake, before reaching safety conclusions. Nevertheless, these data contribute to real-world evidence on the use of PEG 3350+E in this population.
Nurse Leaders' Knowledge and Confidence Managing Disasters in the Acute Care Setting
Authors: Cariaso-Sugay John , Hultgren Marianne , Browder Beth A. , Chen Jyu-Lin
Published: February 2021

Whether natural or human-induced, disasters are a global issue that impact health care systems' operations, especially in the acute care setting. The current COVID-19 pandemic is a recent illustration of how health care systems and providers, especially nurses, respond to a rapidly evolving crisis. Nurse leaders in the acute care setting are pivotal in responding to the multifactorial challenges caused by a disaster. A quality improvement project was developed to increase nurse leaders' knowledge and confidence in disaster management during the COVID-19 pandemic at 2 Magnet-designated acute care hospitals within the John Muir Health system in Northern California. A total of 50 nurse leaders initially participated in this project, with 33 participants completing the postintervention survey. Results indicated significant improvement in perceived knowledge and confidence in disaster management after the intervention. Qualitative responses from project participants highlighted the need to annualize educational opportunities to sustain knowledge and consistently review emergency management operations plans. This quality improvement project provided an approach to educating nurse leaders in disaster management to promote resilience, support of employees, and optimal patient outcomes during disasters.
Storying the Past and the Future
Authors: Jensen Rikke Amalie Agergaard , Thomsen Dorthe Kirkegaard , Lind Majse , Ladegaard Nicolai , Bliksted Vibeke Fuglsang
Published: February 2021

Research has linked disturbances in narrative identity with schizophrenia and other psychiatric disorders. One such disturbance is diminished agency and communion themes in past life stories. However, projecting oneself into the future is also central to identity and potentially impacts recovery. Hence, we examined themes of agency and communion in both past and future life stories and related themes to psychosocial functioning in 20 individuals with schizophrenia, 20 individuals with depressive disorder, and 19 nonpsychiatric controls. Participants were asked to describe up to 10 past and future chapters in their life stories and were assessed on psychosocial functioning and neurocognition. Chapters were coded for agency and communion themes. Both clinical groups displayed diminished agency and communion themes in past but not future life story chapters compared with the nonpsychiatric controls. Furthermore, agency themes in future chapters explained variance in psychosocial functioning after controlling for neurocognition. The results suggest that constructing a narrative identity to foster agency and communion in both past and future chapters may be an important part of recovering from schizophrenia and depression.
Health-Promoting Leadership During an Infectious Disease Outbreak
Authors: Booth Laurel C. , Schwalb Molly E. , Kim Paul Y. , Adler Amy B.
Published: February 2021

Infectious disease outbreaks are uniquely stressful for essential employees. One way to support workers is for supervisors to engage in behaviors promoting employees' well-being and attitudes toward preventive medicine practices. We examined whether health-promoting leadership contributes to these outcomes in a population of active-duty soldiers (N = 173) deployed to provide nonmedical support in Liberia during the 2014 Ebola epidemic using data reported in Sipos, Kim, Thomas, and Adler (Mil Med 183[3–4]:e171–e178, 2018). Soldiers completed surveys assessing posttraumatic stress disorder (PTSD), depression, anxiety, sleep problems, burnout, morale, and attitudes and rated their leaders on health-promoting behaviors. Using mixed-effects logistic regression, health-promoting leadership focused on psychological health was associated with decreased odds of PTSD, depression, anxiety, and burnout, and increased odds of high morale and avoiding unnecessary risk. Health-promoting leadership focused on preventive medicine was associated with decreased odds of depression and anxiety, and increased odds of high morale, positive attitudes, and avoiding unnecessary risk. Findings suggest health-promoting leadership could be valuable for workers responding to epidemics.
An Analysis of Computed Tomography-Related Radiation Exposure in Pediatric Trauma Patients
Authors: Hrdy Michael , Mahesh Mahadevappa , Miller Marlene , Klein Bruce , Stewart Dylan , Ryan Leticia Manning
Published: February 2021

Objective

To compare radiation doses used for pediatric computed tomography (CT) scans at community-based referring facilities (RF) to those at a designated pediatric trauma center (PTC) to assess the consistency of radiation exposure.

Methods

In this retrospective study, patients 0 to 18 years of age with CT imaging performed either at a RF or at a PTC from January 1, 2015, to January 5, 2016, were identified. Data about patients, CT radiation dose, and characteristics of the RFs were compared.

Results

We identified 502 patients (156 RF, 346 PTC) with 281 head CTs (79 RF, 202 PTC) and 86 abdominal/pelvis CTs (28 RF, 58 PTC). The radiation dose (measured in mean dose-length product [DLP] ± 1 standard deviation) was significantly higher for RF scans compared with PTC scans (head, RF DLP = 545 ± 334 vs PTC DLP = 438 ± 186 (P < 0.001); abdomen/pelvis, RF DLP = 279 ± 160 vs PTC DLP = 181 ± 201 [P = 0.027]). There was a nonsignificant trend toward lower head CT radiation dosages at RFs with a dedicated pediatric emergency department compared with RFs without a pediatric emergency department.

Conclusions

Our data suggest that CT scans performed at RFs expose pediatric patients to significantly higher doses of radiation when compared with a PTC. These data support further study to identify factors associated with increased radiation and educational outreach to RFs.
Short Walking Exercise Leads to Gait Changes and Muscle Fatigue in Children With Cerebral Palsy Who Walk With Jump Gait
Authors: Parent Audrey , Dal Maso Fabien , Pouliot-Laforte Annie , Cherni Yosra , Marois Pierre , Ballaz Laurent
Published: February 2021

Objective

The aim of this study was to evaluate kinematic changes and muscle fatigue in jump gait during a walking exercise and the relationship between kinematic changes and muscle fatigue and strength.

Design

This preliminary study included 10 children with cerebral palsy who walk with jump gait. Hip and knee maximal isometric muscle strength were measured using a dynamometer. Then, lower-limb kinematics and electromyography were collected while children walked continuously for 6 min at their self-selected speed. Electromyography median frequency and lower-limb joint angles were compared between the first and the sixth minutes of the walking exercise usingttest and Wilcoxon rank test. The relationship between kinematic changes and muscle strength and changes in electromyography median frequency were assessed using correlation analyses.

Results

During stance, maximal knee flexion significantly increased at the sixth minute (P= 0.01) and was associated with knee extensor muscle weakness (ρ= −0.504,P= 0.03). Muscle fatigue was observed only in the gluteus medius muscle (P= 0.01).

Conclusions

Children with cerebral palsy who walked with jump gait and who had knee extensor weakness were more prone to an increase in knee flexion during a continuous walk. The fatigue in the gluteus medius muscle suggests that physical intervention should target the endurance of this muscle to improve jump gait.
Reducing Employee Injury Rates with a Hospital-wide Employee Safety Program
Authors: Fink Alia , Merkeley Kathryn , Tolliver Charika , McLeese Raven , Mason Janice J. , Mantasas Nikolas , Cheng Jenhao Jacob , Roberts-Turner Reneè , Fahey Lisbeth , Parra Martha , Talley Linda , Cady Rebecca , Shah Rahul K.
Published: February 2021

Introduction:

Despite the well-known dangers of working in the healthcare industry, healthcare organizations have historically accepted workplace injuries as business as usual. In 2017, Children’s National Hospital began our Employee and Staff Safety program to drive down the employee injury rate and address this disturbing industry trend.

Methods:

With guidance and support from executive leadership, we created an Employee and Staff Safety program that aligned employee safety work with existing patient safety and quality improvement efforts. Team leads collected and analyzed baseline employee injury data and identified areas of highest injuries. Dedicated subcommittees focused on five specific areas: slips, trips, and falls; sharps injuries; blood and body fluid exposures; verbal and physical violence; and overexertion injuries. Subcommittees established aims, identified key drivers, and brainstormed interventions for tests of change.

Results:

Because the inception of the Employee and Staff Safety program, Children’s National has seen significant reductions in our Days Away Restricted or Transfer (DART) rate. The DART rate shows a sustained 37% reduction since the baseline period of FY16–FY17 (1.48 injuries/200,000 h worked to 0.93 injuries/200,000 h worked). The regression trend shows a significant decrease (38.3%) in DART injuries, from 1.544 to 0.952 over 56 months; P = 0.016.

Conclusions:

Active leadership support and analyzing data on specific employee harm areas coupled with targeted interventions, helped improve Children’s National’s DART rate. The Employee and Staff Safety program’s success in utilizing patient safety and quality improvement tools creates a generalizable framework for other hospitals to advance their high-reliability journey.
Morbidity and Mortality Caused by Noncompliance With California Hospital Licensure: Immediate Jeopardies in California Hospitals, 2007–2017
Authors: Zheng Micha Y. , Lui Hansen , Patino German , Mmonu Nnenaya , Cohen Andrew J. , Breyer Benjamin N.
Published: February 2021

Objective

The California Department of Public Health investigates compliance with hospital licensure and issues an administrative penalty when there is an immediate jeopardy. Immediate jeopardies are situations in which a hospital’s noncompliance of licensure requirements causes serious injury or death to patient. In this study, we critically examine immediate jeopardies between 2007 and 2017 in California.

Methods

All immediate jeopardies reported between 2007 and 2017 were abstracted for hospital, location, date, details of noncompliance, and patient’s health outcome.

Results

Of 385 unique immediate jeopardies, 141 (36.6%) caused mortality, 120 (31.2%) caused morbidity, 96 (24.9%) led to a second surgery, 9 (2.3%) caused emotional trauma without physical trauma, and 19 (4.9%) were caught before patients were harmed. Immediate jeopardy categories included the following: surgical (34.2%), medication (18.9%), monitoring (14.2%), falls (7.8%), equipment (5.4%), procedural (5.4%), resuscitation (4.4%), suicide (3.9%), MD/RN miscommunication (3.4%), and abuse (2.3%).

Conclusions

Noncompliance to hospital licensure causes significant morbidity and mortality. Statewide hospital licensure policies should focus on enacting standardized reporting requirements of immediate jeopardies into an Internet-based form that public health officials can regularly analyze to improve hospital safety.
Clinical Characteristics and Outcomes of Mexican Patients With Polyarteritis Nodosa
Authors: Sánchez-Cubías Susy Marcela , Martín-Nares Eduardo , Hernández-Molina Gabriela , Hinojosa-Azaola Andrea
Published: February 2021

Objective

The aim was to describe the clinical characteristics and outcomes of Mexican patients with polyarteritis nodosa (PAN) from a single center.

Methods

We conducted a medical records review study (1975–2018) that included patients with childhood- and adult-onset PAN. Demographics, organ involvement, phenotype, treatment, and outcomes were assessed and compared against previously published cohorts.

Results

Thirty-one patients were included, 20 (64.5%) female, with a median age at diagnosis of 28 years (interquartile range [IQR], 16–42). Seven (23%) were classified as cutaneous; 23 (74%), systemic; and 1 (3%), progressive systemic phenotype. Eleven patients (35%) had childhood-onset PAN. Most common manifestations were musculoskeletal (71%), cutaneous (68%), constitutional (61%), peripheral neuropathy (39%), and gastrointestinal (29%). The median Birmingham Vasculitis Activity Score and Five-Factor Score at diagnosis were 9 (IQR, 4–13) and 1 (IQR, 0–1), respectively. Most patients were treated with glucocorticoids (94%). Twenty-four (80%) achieved complete and 6 (20%) partial remission at a median follow-up time of 30 months (8–192 months). The median Vasculitis Damage Index at last follow-up was 1 (IQR, 0–1). Nineteen (66%) experienced relapses. Patients with childhood-onset PAN more frequently had central nervous system and gastrointestinal involvement (36% vs 5%, p = 0.04 and 64% vs 10%, p = 0.003, respectively), microaneurysms (100% vs 38%, p = 0.02), and lower levels of C-reactive protein (0.3 vs 15.4 mg/dL, p = 0.03), compared with adult-onset PAN patients.

Conclusions

Our cohort of PAN patients showed predominantly a systemic phenotype. Outcomes were generally good, with most patients achieving complete remission. Childhood-onset differed from adult-onset PAN in terms of clinical and serological characteristics, whereas clinical manifestations and outcomes may be different than the ones reported in other cohorts.
A Machine Learning Approach for Predicting Sustained Remission in Rheumatoid Arthritis Patients on Biologic Agents
Authors: Venerito Vincenzo , Angelini Orazio , Fornaro Marco , Cacciapaglia Fabio , Lopalco Giuseppe , Iannone Florenzo
Published: February 2021

Background

Despite several studies having identified factors associated with successful treatment outcomes in rheumatoid arthritis (RA), there is a lack of accurate predictive models for sustained remission in patients on biologic agents. To the best of our knowledge, no machine learning (ML) approaches apart from logistic regression (LR) have ever been tried on this class of problems.

Methods

In this longitudinal study, patients with RA who started a biological disease-modifying antirheumatic drug (bDMARD) in a tertiary care center were analyzed. Demographic and clinical characteristics were collected at treatment baseline, 12-month, and 24-month follow-up. A wrapper feature selection algorithm was used to determine an attribute core set. Four different ML algorithms, namely, LR, random forest, K-nearest neighbors, and extreme gradient boosting, were then trained and validated with 10-fold cross-validation to predict 24-month sustained DAS28 (Disease Activity Score on 28 joints) remission. The performances of the algorithms were then compared assessing accuracy, precision, and recall.

Results

Our analysis included 367 patients (female 323/367, 88%) with mean age ± SD of 53.7 ± 12.5 years at bDMARD baseline. Sustained DAS28 remission was achieved by 175 (47.2%) of 367 patients. The attribute core set used to train algorithms included acute phase reactant levels, Clinical Disease Activity Index, Health Assessment Questionnaire–Disability Index, as well as several clinical characteristics. Extreme gradient boosting showed the best performance (accuracy, 72.7%; precision, 73.2%; recall, 68.1%), outperforming random forest (accuracy, 65.9%; precision, 65.6%; recall, 59.3%), LR (accuracy, 64.9%; precision, 62.6%; recall, 61.9%), and K-nearest neighbors (accuracy, 63%; precision, 61.5%; recall, 54.8%).

Conclusions

We showed that ML models can be used to predict sustained remission in RA patients on bDMARDs. Furthermore, our method only relies on a few easy-to-collect patient attributes. Our results are promising but need to be tested on longitudinal cohort studies.
68Ga-FAPI and 18F-FDG PET/CT in Perineum Extramammary Paget Disease
Authors: Jiang Chunjuan , Song Shaoli
Published: February 2021

Extramammary Paget disease is a rare skin intraepithelial adenocarcinoma. Our case presents 68Ga-fibroblast activation protein inhibitor and 18F-FDG PET/CT imaging in a patient with perineum extramammary Paget disease. Compared with 18F-FDG PET/CT, the primary tumor, enlarged pelvic lymph nodes and right maxillofacial lesion showed higher uptake in 68Ga-fibroblast activation protein inhibitor PET/CT.
Quality and Safety in Healthcare, Part LXXXV
Authors: Harolds Jay A.
Published: February 2021

A high-reliability organization must have high-performing teams. Core teams in healthcare should include the patient and, where possible, the patient’s family. Everyone on the team should understand what is expected of them in terms of expertise, leadership, communication, mutual support, and awareness of the situation. One test of the excellence of a clinical team is having high-quality handoffs of patients.