bluuebunny/crossref_metadata_2025 huggingface dataset:
Opioid use trajectories after thoracic surgery among veterans in the United States
Authors: Bishop Michael O. , Bayman Emine O. , Hadlandsmyth Katherine , Lund Brian C. , Kang Sinyoung
Published: June 2020

Background

Opioid use has increased to epidemic levels over the past decade within the United States, particularly among vulnerable populations. This retrospective study aimed to evaluate rates of prolonged opioid use in the Veteran population after thoracic surgery and identify specific risk clusters.

Methods

Veterans Administration data on patients who underwent thoracic surgery between January 1, 2006 and September 30, 2015 included preoperative opioid use information for stratification of patients to preoperative chronic opioid use (PCOU; nPCOU = 16,612) versus patients without preoperative chronic opioid use (WPCOU; nWPCOU = 2,328). A Poisson regression model and prior literature were used to identify variables for use in a Latent Class Analysis (LCA) model for each stratum. Three‐cluster models were selected, and identified as ‘low‐’, ‘intermediate‐’ and ‘high‐’ risk groups.

Results

Cluster interpretations included: (a) Low risk: no psychiatric diagnoses, preoperative medication use, or preoperative chronic pain, (b) Intermediate risk: no psychiatric diagnoses, but had preoperative medication use and some preoperative chronic pain and (c) High risk: psychiatric diagnoses, preoperative medication use and preoperative chronic pain. For the PCOU stratum, rates of prolonged opioid use 1 year after surgery were as follows: 46.3%, 61.9% and 66.0%. For the WPCOU stratum, the observed rates were 4.7%, 8.3% and 9.2%.

Conclusions

Prolonged opioid use trajectories obviously differ by PCOU status, as well as preoperative psychosocial diagnoses, medication use and chronic pain. This is a first step in population‐level research to curb the rate of prolonged opioid use in Veterans following thoracic surgery.

Significance

This article presents population‐level chronic opioid use trajectories after thoracic surgery, using latent class structures. Demographics, preoperative psychological diagnoses, medication usage and chronic pain variables were utilized to identify population‐level clusters. The cluster identified as highest risk had preoperative chronic opioid use, psychological diagnoses, other medication prescriptions and chronic pain.
Experimental study of biosorption of fluoride by immobilized beads of zeolite NaA and Nostoc sp. (BTA394) using a continuous flow system
Authors: Mukherjee Shraboni , Khan Anoar Ali , Barman Sanghamitra , Halder Gopinath
Published: June 2020

The current experiment investigated the fluoride sorptive efficacies of immobilized beads of zeolite NaA and Nostoc sp. (BTA394) from simulated wastewater in column reactor. Influence of crucial kinetic parameters viz. initial concentration (10, 15, and 20 mg/L), bed height (4, 6, and 8 cm) and flow rate (2, 4, and 6 ml/min) on F− uptake was examined. Influence of these parameters on breakthrough curves was also determined. These breakthrough curves were further estimated by Adams–Bohart's and Thomas models. Spent column was eluted with 0.01 M NaCl, Ca(OH)2, Na2SO4, or NaOH solution to assess column regeneration efficacy. The Thomas model satisfactorily explained the sorption dynamics but Adams–Bohart model could only explicate preliminary portion of the column sorption mechanism. The exhaustion and breakthrough time shortened with increased flow rate, decreased bed height and increased F− concentration. Safe disposal of spent biosorbents were also performed. From the results obtained, it can be said that these biosorbents could be used effectively in treatment of simulated wastewater in continuous flow, although further experiments are being carried out to assess their defluoridation capabilities for real wastewater in large‐scale operations.
High‐efficiency preparation of Fe–Al based flocculants from red mud by microwave selective carbothermic reduction and magnetic separation
Authors: Zhang Junhong , Guo Qing , Tian Chen , Zhan Wenlong , Chen Shuwen , He Zhijun
Published: June 2020

Fe–Al based flocculants (PAFC) have been widely used in sewage treatment. In this article, a new method for preparing PAFC from red mud was proposed, the magnetic product was upgraded and “downgrading Fe of red mud” was obtained based on a microwave selective carbothermic reduction and magnetic separation technique. The results showed that the Fe and Al contents in “downgrading Fe of red mud” were determined to be 24.60% and 22.27%, respectively. The Fe and Al digestion rates of “downgrading Fe of red mud” were 81.24% and 28.55% during the preparation of PAFC, respectively. The prepared PAFC can effectively achieve the effect of sewage treatment, and the turbidity removal rate of sewage reached 88.17%. In addition, microwave can realize rapid reduction at low temperature, and the magnetite obtained by magnetic separation can be used in the iron‐making process to realize the recycling of resources.
Fire hazard of compressed straw as an insulation material for wooden structures
Authors: Blondin Frederic , Blanchet Pierre , Dagenais Christian , Triantafyllidis Zafiris , Bisby Luke
Published: June 2020

The construction sector continues to adapt to the challenges posed by climate change. Architects and engineers aim to build sustainable, energy, resource, and cost‐efficient structures by increasingly using bio‐based building materials. However, fire safety has always been a significant concern for timber building construction internationally. The objective of the study presented in this article is to document fire hazards of compressed straw when used as thermal and acoustic insulation within wood‐framed building assemblies. Three densities of compressed straw (75, 125, and 175 kg/m3) were selected and their combustion and thermal responses were evaluated at various scales, in attempt to define the optimal density considering various factors. The performance of the straw was also compared with commercially available insulation materials and then tested under exposure to severe heating in medium‐scale wood‐framed assemblies to evaluate the impacts of the straw as compared with a noncombustible insulation. The compressed straw with a density of 75 kg/m3 was found to have the best behavior with respect to both reactions to fire and insulation properties. The results suggest that compressed may have similar or better behavior under the heating conditions investigated when compared to a commercially available combustible insulation material. The use of this material as a primary insulation in a buildings is considered manageable by thoughtful design, construction, and building use without unduly increasing risks associated with fire.
Performance of a ventilated‐façade system under fire conditions: An experimental investigation
Authors: Asimakopoulou Eleni K. , Kolaitis Dionysios I. , Founti Maria A.
Published: June 2020

During a fire event, ventilated facade systems may contribute to external fire spreading to the upper floors of a building via the facade, thus representing a significant risk. In this frame, the performance of a typical ventilated façade system under fire conditions is experimentally investigated, using a full‐scale compartment‐facade test rig. Two alternative façade configurations are examined and comparatively assessed, namely a plain façade (PF) and a ventilated façade (VF) system. Emphasis is given on the estimation of the thermal characteristics of the developed Externally Venting Flames (EVF) and the thermal boundary conditions developing on the façade's exposed surface. An extensive set of sensors was installed at the interior of the fire compartment, the façade systems and the exterior of the test configurations. Analysis of the experimental data suggests that even though gaseous combustion products managed to penetrate the air cavity of the VF system, no consistent flaming conditions were established. On the unexposed face of both PF and VF systems, temperatures remained constantly below 180°C throughout the duration of both fire tests. The Eurocode correlations are assessed against the obtained experimental data; certain parameters, such as EVF length, width and centreline temperature, are found to be under‐estimated by the Eurocode methodology.
Micro-Fishing as an Emerging Form of Recreational Angling: Research Gaps and Policy Considerations
Authors: Cooke Steven J , Lennox Robert J , Cantrell Ben , Danylchuk Andy J
Published: June 2020

Micro-fishing is an emerging form of recreational angling that targets small-bodied fish in inland and marine waters. Although most fish are presumably released, some are retained as specimens for home aquaria or dissection to confirm identification. To date, very little is known about the effects of Micro-fishing on individuals (e.g., stress, injury, mortality), populations, or communities owing to a historical focus on large-bodied species in recreational fisheries. We identify a list of research gaps that should be addressed to better elucidate motivations and identify any potential negative effects of Micro-fishing and how they could be mitigated. We also consider the implications of Micro-fishing for policy and management, recognizing the many uncertainties given lack of empirical research.
Has Steller Sea Lion Predation Impacted Survival of Fraser River Sockeye Salmon?
Authors: Walters Carl J , McAllister Murdoch K , Christensen Villy
Published: June 2020

The commercially, recreationally, and culturally important Fraser River Sockeye Salmon Oncorhynchus nerka has experienced a productivity decline over the past 3 decades, which—along with greater temporal variation in annual abundance (i.e., cyclic dominance)—may at least partly be due to Steller sea lion Eumetopias jubatus (SSL) predation on returning adult salmon. This assumes that SSLs residing around northern Vancouver Island (British Columbia, Canada) target Sockeye Salmon for just a few weeks during the peak of their run. It is a reasonable enough assumption to warrant immediate priority for field research on SSL behavior and diets during the migration period. We evaluated the plausibility of the assumption with a variety of approaches ranging from simple estimates of maximum SSL consumption to partitioning of observed marine mortality rates and analysis of SSL foraging behavior to show that SSLs could have caused the decline in productivity and abundance of Fraser River Sockeye Salmon.
Bioenergetic Habitat Suitability Curves for Instream Flow Modeling: Introducing User-Friendly Software and its Potential Applications
Authors: Naman Sean M , Rosenfeld Jordan S , Neuswanger Jason R , Enders Eva C , Hayes John W , Goodwin Eric O , Jowett Ian.G , Eaton Brett C
Published: June 2020

Habitat suitability curves (HSCs) are the biological component of habitat simulation tools used to evaluate instream flow management trade-offs (e.g., the physical habitat simulation model). However, traditional HSCs based on empirical observations of habitat use relative to availability have been criticized for generating biased estimates of flow requirements and for being poorly transferable across locations. For fish like salmonids that feed on drifting invertebrates, bioenergetics-based foraging models that relate habitat conditions to net energy gain offer an alternative approach that addresses some of these shortcomings. To make this technique more accessible for practitioners, we present free and user-friendly software for generating bioenergetics-based HSCs. The software also allows sensitivity analyses of HSCs to factors like fish size or prey abundance as well as direct integration of hydraulic data. While some caveats remain, bioenergetic HSCs should offer a more rigorous and credible means for quantifying habitat suitability for instream flow modeling.
Subcutaneous administration of casein attenuates atherosclerotic progression in male apoE‐/‐ mice fed with high‐fat diet
Authors: Hou Lingbo , Wang Yuting , Zhang Mingjing , Yu Yijun , Gu Ye
Published: June 2020

The impact of casein on atherosclerotic lesion progression remains controversial. In this study, we tested the effect of casein on atherosclerotic development and its potential mechanisms in male apolipoprotein E knockout (apoE‐/‐) mice fed with high‐fat diet (HFD). Male apoE‐/‐ mice fed with HFD were randomized into HFD group (subcutaneous injection with 0.5 ml of 0.9% sodium chloride daily, n = 6) and HFD + Casein group (subcutaneous injection with 0.5 ml of 10% casein daily, n = 6). Body weight was recorded at baseline and once a week thereafter. After 12 weeks of treatment, plasma lipid and inflammatory markers, and histological characterization of atherosclerotic plaques in the aortic arch and aortic sinus were analyzed. There was no significant difference in weight gain between the two groups after 12 weeks of treatment. Plasma levels of total cholesterol (TC), triglyceride (TG), and low‐density lipoprotein cholesterol (LDL‐C) were significantly lower, while high‐density lipoprotein cholesterol (HDL‐C) level tended to be higher in the HFD + Casein group compared with the HFD group. The positive percentages of atherosclerotic lesions in aortic arch and aortic sinus as well as collagen deposition in aortic sinus plaques were significantly lower in the HFD + Casein group compared with the HFD group. Plasma levels of interleukin (IL)‐1β and granulocyte‐macrophage colony‐stimulating factor (GM‐CSF) were also significantly lower in the HFD + Casein group compared with the HFD group. In conclusion, subcutaneous administration of casein attenuates atherosclerotic lesion progression, possibly through decreasing fibrosis and inflammatory responses in male apoE‐/‐ mice fed with HFD.
Soft tissue tumors characterized by a wide spectrum of kinase fusions share a lipofibromatosis‐like neural tumor pattern
Authors: Kao Yu‐Chien , Suurmeijer Albert J. H. , Argani Pedram , Dickson Brendan C. , Zhang Lei , Sung Yun‐Shao , Agaram Narasimhan P , Fletcher Christopher D. M. , Antonescu Cristina R.
Published: June 2020

Gene fusions resulting in oncogenic activation of various receptor tyrosine kinases, including NTRK1‐3, ALK, and RET, have been increasingly recognized in soft tissue tumors (STTs), displaying a wide morphologic spectrum and therefore diagnostically challenging. A subset of STT with NTRK1 rearrangements were recently defined as lipofibromatosis‐like neural tumors (LPFNTs), being characterized by mildly atypical spindle cells with a highly infiltrative growth in the subcutis and expression of S100 and CD34 immunostains. Other emerging morphologic phenotypes associated with kinase fusions include infantile/adult fibrosarcoma and malignant peripheral nerve sheath tumor‐like patterns. In this study, a large cohort of 73 STT positive for various kinase fusions, including 44 previously published cases, was investigated for the presence of an LPFNT phenotype, to better define the incidence of this distinctive morphologic pattern and its relationship with various gene fusions. Surprisingly, half (36/73) of STT with kinase fusions showed at least a focal LPFNT component defined as >10%. Most of the tumors occurred in the subcutaneous tissues of the extremities (n = 25) and trunk (n = 9) of children or young adults (<30 years old) of both genders. Two‐thirds (24/36) of these cases showed hybrid morphologies with alternating LPFNT and solid areas of monomorphic spindle to ovoid tumor cells with fascicular or haphazard arrangement, while one‐third (12/36) had pure LPFNT morphology. Other common histologic findings included lymphocytic infiltrates, staghorn‐like vessels, and perivascular or stromal hyalinization, especially in hybrid cases. Mitotic activity was generally low (<4/10 high power fields in 81% cases), being increased only in a minority of cases. Immunoreactivity for CD34 (92% in hybrid cases, 89% in pure cases) and S100 (89% in hybrid cases, 64% in pure cases) were commonly present. The gene rearrangements most commonly involved NTRK1 (75%), followed by RET (8%) and less commonly NTRK2, NTRK3, ROS1, ALK, and MET.
Risk factors for high‐dose methotrexate associated acute kidney injury in patients with hematological malignancies
Authors: Amitai Irina , Rozovski Uri , El‐Saleh Reem , Shimony Shai , Shepshelovich Daniel , Rozen‐Zvi Benaya , Raanani Pia , Gafter‐Gvili Anat , Gurion Ronit
Published: June 2020

High dose methotrexate (HDMTX)‐induced acute kidney injury (AKI) is a well‐known adverse event in hemato‐oncology patients. Our purpose was to define factors and setup cut‐offs that may help better identify patients at‐risk for developing AKI following HDMTX. All consecutive patients who received MTX dose ≥1 g were retrospectively reviewed. We compared patients with or without renal toxicity. We used a logistic regression model to define baseline variables associated with AKI. Overall survival (OS) was estimated by the Kaplan‐Meier method employing log‐rank test. Between 2012 and 2017, 160 patients were included with a total of 265 courses. Indications included: primary central nervous system (CNS) lymphoma, CNS prophylaxis in other lymphoma types, acute lymphatic leukemia and others. Median age at diagnosis was 58 years (range, 18‐84), 54% were males, median MTX dose was 1941 mg/m2 (range, 743‐5442) and AKI developed in 9% of drug administrations (n = 24). In univariate analysis: age > 40, LDH > 380 units/L, eGFR < 112 mL/min, albumin <3.6 mg/dL at baseline and Charlson comorbidity index (CCI) were associated with AKI. In multivariable analysis, only LDH > 380 units/L (OR = 4.1, 95% confidence interval [CI] 1.04‐20.9, P = .04) and albumin levels <3.6 g/dL (OR = 4.17, 95% CI 1.04‐6.5, P = .04) remained significant. In patients with AKI, median drug elimination was longer (8 days vs 5 days). In 80% of cases, the creatinine levels returned to normal within 1 month. Yet, the median survival of patients who developed AKI was 37 months, compared to 145 months in patients without AKI (Log rank = 0.015). In conclusion, LDH > 380 units/L and albumin <3.6 g/dL were the strongest factors associated with AKI in patients receiving HDMTX. Although the rise in creatinine levels was almost uniformly reversible, AKI was associated with increased mortality rates.
A critical food system program in South Australia and the effects on consumer knowledge and attitudes
Authors: Mehta Kaye , Rohrlach Hannah , Woodman Richard , Coveney John , Ward Paul , Booth Sue
Published: June 2020

Issue addressed

This study investigated the effects of food system literacy on knowledge and attitudes of food consumers.

Methods

A 2‐week online course critically discussed the food system through three lenses of environmental sustainability, equity and health. Participants were randomly allocated into one Control and two Intervention groups (A & B). Data collection was by online questionnaire pre‐ and postintervention, addressing self‐perceived food system knowledge, attitudes towards food purchasing behaviours, demographic characteristics and course evaluation. Differences in knowledge and attitude scores between Control and Intervention groups were assessed. Subjects were staff and students of Flinders University in South Australia.

Results

Forty‐seven participants completed the course. The completion rate was 71.2%. Knowledge about the food system improved significantly for both Intervention groups when compared to the Control group (P ≤ 0.001). Although attitudes towards food purchasing behaviours also improved significantly for both Intervention groups (P < 0.001 and P = 0.005 for Interventions A and B respectively), the improvements were not significant when compared to the Control group (P = 0.065 and P = 0.43 for Interventions A and B respectively). The online methodology received positive feedback from participants.

Conclusion

This 2‐week online food system course showed that the pedagogy was appropriate and successful in improving self‐perceived knowledge and attitudes towards food consumption.

So what?

It provides encouraging indications of the potential of food system literacy to empower citizens to make healthier as well as, more environmentally and socially sustainable food choices.
Supporting visitor compliance with a smoke‐free policy at hospital using a nicotine replacement therapy vending machine
Authors: Giles Luke , Bauer Lyndon A.
Published: June 2020

Issue addressed

To support visitors to comply with Central Coast Local Health District's (CCLHD) smoke‐free hospital grounds policy, a need was identified for round‐the‐clock availability of nicotine replacement therapy (NRT). Providing NRT through a vending machine was identified as a possible solution. This initiative complemented other strategies that provide staff and patients who smoke with NRT.

Methods

NRT was originally provided through a snack vending machine; however, there were commercial and regulatory concerns with this method.

In 2015, dedicated NRT vending machines were installed at Gosford and Wyong Hospitals, and were operated by the Health Promotion Service. The appropriate regulatory permission was gained to supply a specific brand of NRT. Sales and incident data were recorded, and ongoing smoking counts were performed both before and after installation.

Results

In all, 247 sales of NRT gum were made through the vending machines from early 2017 to late 2019. Smoking counts show that there are very low rates of visitor smoking (<1%) in the approximately 4.5 years pre‐ and post‐installation of dedicated vending machines. There was no statistically significant change in the smoking rate of visitors since the vending machine was installed at Wyong Hospital.

Conclusions

While NRT is generally provided to patients and staff within health settings to support compliance with smoke‐free policies, alternatives to smoking for visitors are typically overlooked. A NRT vending machine achieves this. However, because there are few purchases made, the vending machines as currently operating are unlikely to make any significant impact on smoke‐free policy compliance at these hospitals.

So what?

While vending machines have limited effectiveness on overall smoke‐free policy compliance, this strategy may have applicability to all sectors with smoke‐free policies, especially those operating 24 hours a day, as a means of providing an alternative to smoking for visitors.
β‐Lactam allergy testing and delabeling—Experiences and lessons from Singapore
Authors: Heng Yee Kiat , Liew Yasmin Chia Chia , Kong Yan Ling , Lim Yen Loo
Published: June 2020

Background

β‐Lactam allergy is over‐reported and this leads to greater healthcare costs. Allergy testing has inherent risks, yet patients who test negative may continue avoiding β‐lactams.

Objective

To evaluate the safety and diagnostic value of β‐lactams allergy testing locally and usage of antibiotics following negative testing.

Methods

We performed a retrospective medical record review and follow‐up survey of patients who underwent β‐lactam testing between 2010 and 2016 at the National Skin Centre, Singapore.

Results

We reviewed the records of 166 patients, with a total of 173 β‐lactam allergy labels. Eighty (46.2%) labels were to penicillin, 75 (43.1%) to amoxicillin/amoxicillin‐clavulanic acid, 11 (6.4%) to cephalexin, and 5 (2.9%) to others. Skin tests were performed in 142 patients and drug provocation tests (DPTs) in 141 patients. Eleven (6.6%) patients defaulted DPTs after skin testing. Out of 166 patients, 22 (13.3%) patients were proven allergic by either skin tests (16) or DPTs (6). Patients who tested positive had nonsevere reactions.

Out of 155 patients who were conclusively evaluated, 133 (85.8%) were not allergic. Of these patients, 30 (22.6%) used the tested β‐lactam subsequently, with one reporting a mild reaction. Fifty‐one (38.3%) patients were uncontactable or uncertain if they consumed a β‐lactam since testing negative. Fifty‐two (39.1%) patients had no re‐exposure (35 had no indication, 17 were fearful of reactions).

Conclusion

Drug allergy testing was safe and removed inappropriate labels.

Clinical Implication

Allergy testing is efficacious, but fears of subsequent rechallenge should be addressed to maximize the effectiveness of allergy delabeling.
Circadian genes polymorphisms, night work and prostate cancer risk: Findings from the EPICAP study
Authors: Wendeu‐Foyet Méyomo G. , Cénée Sylvie , Koudou Yves , Trétarre Brigitte , Rébillard Xavier , Cancel‐Tassin Géraldine , Cussenot Olivier , Boland Anne , Olaso Robert , Deleuze Jean‐François , Blanché Hélène , Lamy Pierre‐Jean , Mulot Claire , Laurent‐Puig Pierre , Truong Thérèse , Menegaux Florence
Published: June 2020

Over the past two decades, several studies have attempted to understand the hypothesis that disrupting the circadian rhythm may promote the development of cancer. Some have suggested that night work and some circadian genes polymorphisms are associated with cancer, including prostate cancer. Our study aims to test the hypothesis that prostate cancer risk among night workers may be modulated by genetic polymorphisms in the circadian pathway genes based on data from the EPICAP study, a population‐based case‐control study including 1511 men (732 cases/779 controls) with genotyped data. We estimated odds ratio (ORs) and P values of the association between prostate cancer and circadian gene variants using logistic regression models. We tested the interaction between circadian genes variants and night work indicators that were significantly associated with prostate cancer at pathway, gene and SNP levels. Analyses were also stratified by each of these night work indicators and by cancer aggressiveness. The circadian pathway was significantly associated with aggressive prostate cancer among night workers (P = .004), particularly for men who worked at night for <20 years (P = .0002) and those who performed long night shift (>10 hours, P = .001). At the gene level, we observed among night workers significant associations between aggressive prostate cancer and ARNTL, NPAS2 and RORA. At the SNP‐level, no significant association was observed. Our findings provide some clues of a potential modulating effect of circadian genes in the relationship between night work and prostate cancer. Further investigation is warranted to confirm these findings and to better elucidate the biological pathways involved.
Lung cancer mortality associated with protracted low‐dose occupational radiation exposures and smoking behaviors in U.S. radiologic technologists, 1983‐2012
Authors: Velazquez‐Kronen Raquel , Gilbert Ethel S. , Linet Martha S. , Moysich Kirsten B. , Freudenheim Jo L. , Wactawski‐Wende Jean , Simon Steven L. , Cahoon Elizabeth K. , Alexander Bruce H. , Doody Michele M. , Kitahara Cari M.
Published: June 2020

In the Japanese atomic bomb survivors, risk of lung cancer has been shown to increase with greater acute exposure to ionizing radiation. Although similar findings have been observed in populations exposed to low‐dose, protracted radiation, such studies lack information on cigarette smoking history, a potential confounder. In a cohort of 106 068 U.S. radiologic technologists, we examined the association between estimated cumulative lung absorbed dose from occupational radiation exposure and lung cancer mortality. Poisson regression models, adjusted for attained age, sex, birth cohort, pack‐years smoked and years since quitting smoking, were used to calculate linear excess relative risks (ERR) per 100 mGy, using time‐dependent cumulative lung absorbed dose, lagged 10 years. Mean cumulative absorbed dose to the lung was 25 mGy (range: 0‐810 mGy). During the 1983 to 2012 follow‐up, 1090 participants died from lung cancer. Greater occupational radiation lung dose was not associated with lung cancer mortality overall (ERR per 100 mGy: −0.02, 95% CI: <0‐0.13). However, significant dose‐response relationships were observed for some subgroups, which might be false‐positive results given the number of statistical tests performed. As observed in other studies of radiation and smoking, the interaction between radiation and smoking appeared to be sub‐multiplicative with an ERR per 100 mGy of 0.41 (95% CI: 0.01‐1.15) for those who smoked <20 pack‐years and −0.03 (95% CI: <0‐0.15) for those who smoked ≥20 pack‐years. Our study provides some evidence that greater protracted radiation exposure in the low‐dose range is positively associated with lung cancer mortality.
Prophylactic internal iliac artery ligation versus balloon occlusion for placenta accreta spectrum disorders: A retrospective cohort study
Authors: Papillon‐Smith Jessica , Hobson Sebastian , Allen Lisa , Kingdom John , Windrim Rory , Murji Ally
Published: June 2020

Objective

To compare surgical outcomes between women undergoing prophylactic internal iliac artery ligation or preoperative placement of balloon‐occlusive devices at cesarean hysterectomy for placenta accreta spectrum (PAS) disorders.

Methods

A retrospective cohort study was conducted at a tertiary‐care referral center for PAS disorders in Ontario, Canada. Eligible electronic records were reviewed of women undergoing cesarean hysterectomy for PAS disorders between November 2012 and June 2018. Outcomes for the ligation and balloon groups were compared primarily on procedure‐related complications and secondarily on total procedure time, bleeding and transfusion metrics, and intraoperative and postoperative complications.

Results

Of the 79 cases of cesarean hysterectomy, 47 underwent balloon placement and 32 underwent ligation. Baseline characteristics between the groups were similar except for more emergency procedures in the ligation group (37.5% vs 12.8%, P=0.014). The balloon‐related complication rate was 5/47 (10.6%), with no reported complications in the ligation group (P=0.077). Procedural time was longer in the balloon group (353 ± 14 vs 227 ± 13 minutes, P<0.001). Estimated blood loss was similar (1874 ± 245 mL vs 1713 ± 181 mL, P=0.590).

Conclusion

Women undergoing prophylactic placement of endovascular balloons at caesarean hysterectomy for PAS disorders had a 10.6% procedure‐related complication rate and increased total procedure time, with no decrease in blood loss compared to those undergoing surgical ligation.
A bundled intervention lowers surgical site infection in hysterectomy for benign and malignant indications
Authors: Guo Xiaoyue Mona , Runge Megan , Miller Deborah , Aaby David , Milad Magdy
Published: June 2020

Objective

To evaluate the impact of a surgical site infection (SSI) prevention bundle on SSI rates after hysterectomy for benign and malignant indications at an urban academic medical center.

Methods

The bundled invention was implemented for all abdominal gynecologic surgeries at Prentice Women’s Hospital, Chicago, USA, from August 2016 to January 2017, and officially incorporated in department‐wide policy from February 1, 2017. SSI data were prospectively collected for any open, vaginal, laparoscopic, or robotic hysterectomy for benign or malignant indications performed from February 2017 to January 2018. A retrospective review of all hysterectomies performed from February 2015 to January 2016 was conducted to establish baseline pre‐bundle SSI data.

Results

Among 532 hysterectomies performed post‐bundle implementation, there were two SSIs. By contrast, there were 14 SSIs among 515 hysterectomies in the same period before bundle implementation, representing a decrease in SSI rate from 2.7% to 0.4% (odds ratio, 7.41; 95% confidence interval, 1.67–32.75). The two SSIs in the post‐bundle period occurred in open hysterectomies, whereas 8 (57.1%) SSIs in the pre‐bundle period occurred in minimally invasive hysterectomies.

Conclusion

An SSI prevention bundle was effective for reducing the SSI rate in hysterectomy for both benign and malignant indications.
Value of robotic surgery in endometrial cancer by body mass index
Authors: Gracia Myriam , García‐Santos Javier , Ramirez Mar , Bellón Mónica , Herraiz Miguel A. , Coronado Pluvio J.
Published: June 2020

Objective

To compare perioperative outcomes and complications in robotically assisted laparoscopy (RAL) and standard laparoscopy (SLP) approaches in the treatment of endometrial cancer by body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters).

Methods

A comparative study was carried out of women treated for endometrial cancer at the Hospital Clinico San Carlos from January 2012 to December 2016: 133 patients were operated by RAL and 101 by SLP. Demographic characteristics of the patients, perioperative outcomes and complications were compared in both approaches.

Results

Hospital stay was significantly lower in patients with BMI ≤30 operated with RAL (2 days RAL vs 4 days SLP; P=0.002). Estimated blood loss was significantly lower in the group with BMI<25 (60 mL RAL vs 100 mL SLP; P=0.004) and in the group with BMI ≥30 (87.5 mL RAL vs 180 SLP; P=0.003) operated with RAL. RAL significantly reduced the conversion rate in patients with BMI ≥30 (2 [3.4%] patients RAL vs 6 [27.3%] patients SLP; P=0.004).

Conclusions

RAL has demonstrated advantages in treating obese women with endometrial cancer by reducing blood loss and conversion to laparotomy.
Utility of plasma cell‐free DNA in metastatic castration‐resistant prostate cancer
Authors: Hamano Itsuto , Hatakeyama Shingo , Hamaya Tomoko , Togashi Kyo , Okamoto Teppei , Yamamoto Hayato , Yoneyama Tohru , Yoneyama Takahiro , Hashimoto Yasuhiro , Ohyama Chikara
Published: June 2020

Introduction

Cell‐free DNA is suggested as a prognostic biomarker in metastatic castration‐resistant prostate cancer. However, it remains unknown which parameter of cell‐free DNA is correlated with the progression and prognosis of metastatic castration‐resistant prostate cancer.

Case presentation

A 75‐year‐old man with newly diagnosed prostate cancer (serum prostate‐specific antigen 4891 ng/mL, Gleason score 4 + 5 = 9, cT3bN1M1) was referred to our department. He first received sequential hormonal therapies and was consequently diagnosed metastatic castration‐resistant prostate cancer 64 months after initial treatment. He underwent serial examinations of plasma cell‐free DNA, including concentration, androgen receptor amplification, TP53 point mutation, and PTEN loss. Only the cell‐free DNA concentration increased along with disease progression and declined after the administration of abiraterone and enzalutamide.

Conclusion

This case presented that cell‐free DNA concentration was possibly correlated with response to castration‐resistant prostate cancer treatment and disease progression. Cell‐free DNA concentration was proposed as a potential prognostic biomarker of metastatic castration‐resistant prostate cancer.
Creation and delivery of a clinical pharmacy practice and education program for international participants in the United States
Authors: Shapiro Nancy L. , Lin Hsiang‐Wen , Lau Alan H.
Published: June 2020

Introduction

University of Illinois at Chicago (UIC) College of Pharmacy has a long history of collaborating with institutions around the world to advance pharmacy practice and education through offering programs for practice skills enhancement and curricula transformation.

Objectives

To develop a short‐term summer program on contemporary clinical pharmacy practice and education for pharmacy students and pharmacists, initially from Taiwan, and subsequently expanded to other countries.

Methods

We developed a month‐long program in 2013 for 25 participants from four different universities, which has continued annually for 7 years, with 349 total participants from 10 regions. The program included topics on basic clinical skills, therapeutic management of common disease states, descriptions of unique clinical pharmacy practice models, and patient case‐based teaching. Baseline self‐evaluations of the participants' skills, clinical understanding, and past experiences were conducted, along with weekly program self‐evaluations of the program content, speaker effectiveness, and overall program satisfaction.

Results

A 89% response rate was received for the program evaluations. The mean overall program content was rated at least a 4.4 out of a 5‐point Likert scale every year. Self‐rated comfort level measured before and after program completion showed improvement in all areas including taking medication histories, interviewing patients, writing SOAP notes, taking blood pressures, interpreting lab values, performing inhaler teaching, monitoring warfarin, and performing pediatric dosing (P < .01 for all pre‐ and post‐comparisons). The participants rated the overall program quality as high every year (mean 4.4‐4.9), and the usefulness and organization as well (mean 4.4‐4.8 and 4.3‐4.8, respectively). In addition, most participants reported a high likelihood of recommending the program to others (mean 4.4‐4.9).

Conclusion

Participants reported that the summer program increased their clinical skills and knowledge. The enhanced understanding of clinical practice and education in the United States may help shape their future academic and professional development.
Rapid analysis of disease state in liquid human serum combining infrared spectroscopy and “digital drying”
Authors: Sala Alexandra , Spalding Katie E. , Ashton Katherine M. , Board Ruth , Butler Holly J. , Dawson Timothy P. , Harris Dean A. , Hughes Caryn S. , Jenkins Cerys A. , Jenkinson Michael D. , Palmer David S. , Smith Benjamin R. , Thornton Catherine A. , Baker Matthew J.
Published: June 2020

In recent years, the diagnosis of brain tumors has been investigated with attenuated total reflection‐Fourier transform infrared (ATR‐FTIR) spectroscopy on dried human serum samples to eliminate spectral interferences of the water component, with promising results. This research evaluates ATR‐FTIR on both liquid and air‐dried samples to investigate “digital drying” as an alternative approach for the analysis of spectra obtained from liquid samples. Digital drying approaches, consisting of water subtraction and least‐squares method, have demonstrated a greater random forest (RF) classification performance than the air‐dried spectra approach when discriminating cancer vs control samples, reaching sensitivity values higher than 93.0% and specificity values higher than 83.0%. Moreover, quantum cascade laser infrared (QCL‐IR) based spectroscopic imaging is utilized on liquid samples to assess the implications of a deep‐penetration light source on disease classification. The RF classification of QCL‐IR data has provided sensitivity and specificity amounting to 85.1% and 75.3% respectively.
Photoacoustic and ultrasound (PAUS) dermoscope with high sensitivity and penetration depth by using a bimorph transducer
Authors: Wang Zhiyang , Yang Fei , Ma Haigang , Cheng Zhongwen , Yang Sihua
Published: June 2020

A bimorph transducer was proposed to improve the detection sensitivity and imaging depth of photoacoustic and ultrasound (PAUS) dermoscope. By applying the bimorph transducer, the imaging depth and sensitivity of PAUS dermoscope were enhanced by simultaneously improving excitation efficiency and reception bandwidth. The integrated design of the imaging head of the dermoscope makes it highly convenient for detecting human skin. The PAUS imaging performance was demonstrated via visualizing subcutaneous tumor and depicting full structures of different skin layers from epidermis to subcutaneous tissue. The results confirm that the dermoscope with the bimorph transducer is well suited for PA and US dual‐modality imaging, which can provide multi‐information for skin disease.
Blockade of macrophage adhesion to CD200‐treated polystyrene culture surface
Authors: Zhang Jun , Peng Ching‐An
Published: June 2020

CD200 is an anti‐inflammatory transmembrane glycoprotein in the immunoglobulin superfamily. The interaction of CD200 and its receptor CD200R has shown to inhibit inflammatory response of myeloid cells to foreign materials. The purpose of this study is to create a CD200 immobilized biomaterial surface through polydopamine coating to suppress macrophage cell adhesion and reduce inflammatory cytokine secretion accordingly by macrophages. In this study, tissue‐culture treated polystyrene (TCPS) surface was modified with biotin through polydopamine coating. Purified CD200‐streptavidin fusion protein was then immobilized onto the biotinylated TCPS surface through the high affinity between biotin and streptavidin. Mouse J774A.1 macrophages were seeded on CD200‐immobilized TCPS surface to evaluate the effect of CD200 on preventing macrophage attachment. The effects of CD200‐immobilized TCPS surface on pro‐inflammatory cytokine secretion from J774A.1 macrophages were measured by enzyme‐linked immunosorbent assay. As a result, CD200‐immobilized TCPS surface suppressed macrophage attachment for up to 9 hr. The level of IL‐6 and TNF‐α secreted from J774A.1 macrophages interacted with CD200‐coated TCPS surface was reduced by 36.3% and 32.4%, respectively.
Manipulate intestinal organoids with niobium carbide nanosheets
Authors: Reding Brittney , Carter Prerana , Qi Yijun , Li Zhe , Wu Yue , Wannemuehler Michael , Bratlie Kaitlin M. , Wang Qun
Published: June 2020

Multifunctional two‐dimensional nanosheet materials have attracted attention in biomedical fields due to their unique physiochemical and biological properties. Interactions between intestinal stem cells and Engineered Nanomaterials (ENMs) are an essential area in research with the growing diagnosis of gastrointestinal (GI) diseases. One unique type of two‐dimensional metal carbide nanomaterial, niobium carbide (Nb2C), has shown promising properties for potential applications in this field, such as biocompatibility, stability, and high photothermal conversion efficiency. In this study, Nb2C nanosheets were prepared by spark plasma sintering and HF etching. Various concentrations of Nb2C nanosheets were placed inside intestinal organoids, which mimic the real functions of an intestinal system. These organoids were formed from intestinal crypts that were isolated from mice and grew into self‐maintained systems. Through growth analysis, surface area calculations, and cell viability tests, it was concluded that an optimal concentration of nanosheets exists that may offer stimulation to intestinal cells while having no toxic effects. A high concentration of nanosheets in the organoids inhibited growth, whereas the control and low concentration of nanosheets showed no reduced growth rate. When placed under infrared exposure, the organoids with nanosheets offered stimulation and showed more viability after time as compared to the control organoids with no nanosheets. These results show overall potential benefits of placing low concentration Nb2C nanosheets in intestinal systems to protect and stimulate cell survivability when undergoing various treatments.
Three‐dimensional silk fibroin scaffolds incorporated with graphene for bone regeneration
Authors: Ding Xili , Huang Yan , Li Xiaoming , Liu Suting , Tian Feng , Niu Xufeng , Chu Zhaowei , Chen Diansheng , Liu Haifeng , Fan Yubo
Published: June 2020

Porous three‐dimensional (3D) silk fibroin (SF) scaffolds were widely applied for bone regeneration and showed excellent biocompatibility and biodegradability. Recently graphene was developed for bone scaffolds due to its osteogenic properties. Thus, we combine the SF and graphene to improve the osteogenic properties of SF scaffolds. In our study, we explored the incorporation of SF scaffolds with graphene to develop osteogenic scaffolds capable of accelerating bone formation. The 3D SF scaffolds were fabricated with different contents of graphene (0, 0.5, and 2%). Fluorescence images showed that the graphene nanosheets were homogeneously dispersed in the SF scaffolds. The addition of graphene affected the microarchitecture of the scaffolds. The G/SF scaffolds were cocultured with rat bone marrow‐derived mesenchymal stem cells (rBMSCs) for 21 days. The cell morphology and cell proliferation study suggested that 0 and 0.5% G/SF scaffolds displayed good cell proliferation. In addition, immunofluorescent staining (e.g., osteonectin, osteopontin, and osteocalcin) and ALP activities indicated that the osteogenic properties was more actively exhibited on 0.5% G/SF scaffolds compared with the other groups. Our results indicated that SF scaffolds incorporated with graphene could be an appropriate scaffold for bone tissue engineering.
Comparison of four matrixes for diluting insulin in routine clinical measurements
Authors: Li Honglei , Wang Danchen , Guo Xiuzhi , Xia Liangyu , Wu Qiong , Cheng Xinqi
Published: June 2020

Objective

In our laboratory, 2.36% (6626/280765) samples obtained for insulin evaluation have serum insulin concentrations higher than 300 mU/L, resulting in curves outside the linear range in the insulin release test (IRT). Accordingly, using appropriate dilution protocols to determine insulin concentration accurately is important. Here, we compared the effectiveness and economy of four different solutions for diluting high‐insulin serum in routine clinical measurements.

Method

Residual serum samples with high‐insulin concentrations ranging from 200 to 300 mU/L were collected in Peking Union Medical College Hospital from August to November 2017. Four different matrixes including a Siemens original diluent, pure water, 0.9% NaCl, and low‐insulin serum (labeled as A to D, respectively) were used to dilute the serum in the ratios of 1:2, 1:5, and 1:10.

Results

We found that the linear correlation coefficients of A to D were higher than 0.9. The recovery rates of A to D were 86.4%–104.0%, 73.2%–99.3%, 76.4%–101.3%, and 84.2%–99.7%, respectively. We conclude that the use of 0.9% NaCl, pure water, or low‐insulin serum to dilute high‐serum insulin (>300 mU/L) is feasible and cost‐effective.

Conclusion

We recommend a dilution factor of 1:5 on a Siemens ADVIA Centaur XP® instrument. The clinically reported range was 0.5‐1500 mU/L. For specific samples (>1500 mU/L), we recommended using low‐insulin serum samples for dilution.
Cholic acid and deoxycholic acid induce skeletal muscle atrophy through a mechanism dependent on TGR5 receptor
Authors: Abrigo Johanna , Gonzalez Francisco , Aguirre Francisco , Tacchi Franco , Gonzalez Andrea , Meza María Paz , Simon Felipe , Cabrera Daniel , Arrese Marco , Karpen Saul , Cabello‐Verrugio Claudio
Published: June 2020

Skeletal muscle atrophy is characterized by the degradation of myofibrillar proteins, such as myosin heavy chain or troponin. An increase in the expression of two muscle‐specific E3 ligases, atrogin‐1 and MuRF‐1, and oxidative stress are involved in muscle atrophy. Patients with chronic liver diseases (CLD) develop muscle wasting. Several bile acids increase in plasma during cholestatic CLD, among them, cholic acid (CA) and deoxycholic acid (DCA). The receptor for bile acids, TGR5, is expressed in healthy skeletal muscles. TGR5 is involved in the regulation of muscle differentiation and metabolic changes. In this paper, we evaluated the participation of DCA and CA in the generation of an atrophic condition in myotubes and isolated fibers from the muscle extracted from wild‐type (WT) and TGR5‐deficient (TGR5−/−) male mice. The results show that DCA and CA induce a decrease in diameter, and myosin heavy chain (MHC) protein levels, two typical atrophic features in C2C12 myotubes. We also observed similar results when INT‐777 agonists activated the TGR5 receptor. To evaluate the participation of TGR5 in muscle atrophy induced by DCA and CA, we used a culture of muscle fiber isolated from WT and TGR5−/− mice. Our results show that DCA and CA decrease the fiber diameter and MHC protein levels, and there is an increase in atrogin‐1, MuRF‐1, and oxidative stress in WT fibers. The absence of TGR5 in fibers abolished all these effects induced by DCA and CA. Thus, we demonstrated that CS and deoxycholic acid induce skeletal muscle atrophy through TGR5 receptor.