bluuebunny/crossref_metadata_2025 huggingface dataset:
Geographic Disparities in Access to Cancer Clinical Trials in Canada
Authors: Abdel-Rahman Omar
Published: August 2023

Objective:

This study aims to evaluate geographic disparities in access to cancer clinical trials across Canada.

Methods:

Cancer clinical trial data recorded within the clinicaltrials.gov and reporting the conduct of any of these trials in Canada, 2005 to 2023 were reviewed. Frequency analyses of the number of clinical trials that were registered on clinicaltrials.gov for Canada, individual Canadian provinces, main Canadian urban centers, and different cancer types, according to the funding source (industry versus non-industry), as well as according to different periods (using 3-y intervals) were conducted. Moreover, a comparison of cancer clinical trials per 10,000 persons was done between Canada and the United States.

Results:

The number of cancer clinical trials per 10,000 individuals (according to the 2021 census) in each province/territory varied between 6.79 (New Brunswick) to 0 (the 3 territories). The number of cancer clinical trials in relation to 1000 projected cancer cases for some of the common tumor types in Canada was then reviewed. The highest number was for lymphoma clinical trials (32.85), whereas the lowest number was for bladder cancer clinical trials (7.06). Most of the trials have industry funding (69%). Using 3-year intervals, the highest number of cancer clinical trials was observed from 2014 to 2016 (778 trials), and the lowest number was observed from 2020 to 2022 (633 trials).

Conclusions:

Access to clinical trials in Canada is not equitably distributed, with geographical and primary tumor site disparities. Moreover, access to cancer clinical trials has been negatively impacted during the time of the COVID-19 pandemic.
Perianal Malignancies: A Review for the Dermatologic Surgeon
Authors: Kosche Cory , Rossi Anthony M.
Published: August 2023

BACKGROUND

Perianal malignancies are rare tumors with unique presentations and treatment options.

OBJECTIVE

To review published literature about primary malignancies that present on perianal skin and published guidelines and treatment options.

MATERIALS AND METHODS

A PubMed search was conducted for original articles about perianal malignancies.

RESULTS

Squamous cell carcinoma, basal cell carcinoma, melanoma, and extramammary Paget disease are the most common tumors to present on perianal skin. Anal squamous cell carcinoma incidence is increasing and certain populations may benefit from screening. Surgical management is often recommended for localized perianal tumors.

CONCLUSION

Dermatologic surgeons should be familiar with the presentation and treatment options available for perianal malignancies.
Knockout of Matrix Metalloproteinase 2 Opposes Hypertension- and Diabetes-induced Nephropathy
Authors: Hirata Takashi , Fan Fan , Fan Letao , Amin Ghadir , White Tiffani , Geurts Aron M. , Kojima Naoki , Takahashi Teisuke , Miyata Noriyuki , Williams Jan , Roman Richard J.
Published: August 2023

The progression of chronic kidney disease results from the accumulation of extracellular matrix leading to end-stage renal disease. We previously demonstrated that a broad-spectrum matrix metalloproteinase (MMP) inhibitor reduced renal injury in rat models of hypertension and diabetes. However, the isoforms and mechanisms involved are unclear. This study examined the role of MMP2 during the development of proteinuria and renal injury after induction of hypertension or diabetes in Dahl salt-sensitive (SS) and MMP2 knockout (KO) rats. Mean arterial pressure rose from 115 ± 2 to 145 ± 2 mm Hg and 116 ± 1 to 152 ± 3 mm Hg in MMP2 KO and SS rats fed a high-salt (8% NaCl) diet for 3 weeks. The degree of proteinuria, glomerular injury, renal fibrosis, and podocyte loss was lower in MMP2 KO rats than in SS rats. Blood glucose and HbA1c levels, and mean arterial pressure rose to the same extent in streptozotocin-treated SS and MMP2 KO rats. However, the degree of proteinuria, glomerulosclerosis, renal fibrosis, renal hypertrophy, glomerular permeability to albumin, and the renal expression of MMP2 and TGFβ1 were significantly reduced in MMP2 KO rats. Glomerular filtration rate fell by 33% after 12 weeks of diabetes in streptozotocin-treated SS rats compared with time-control rats, but glomerular filtration rate only fell by 12% in MMP2 KO rats. These results indicate that activation of MMP2 plays an essential role in the pathogenesis of hypertensive and diabetic nephropathy and suggests that an MMP2 inhibitor might slow the progression of chronic kidney disease.
Dapagliflozin Attenuates Heart Failure With Preserved Ejection Fraction Remodeling and Dysfunction by Elevating β-Hydroxybutyrate–activated Citrate Synthase
Authors: Zhang Xinxin , Wang Ning , Fu Peng , An Yanliang , Sun Fangfang , Wang Chengdong , Han Xiao , Zhang Yunlong , Yu Xiaohong , Liu Ying
Published: August 2023

Heart failure with preserved ejection fraction (HFpEF) is highly prevalent, accounting for 50% of all heart failure patients, and is associated with significant mortality. Sodium–glucose cotransporter subtype inhibitor (SGLT2i) is recommended in the AHA and ESC guidelines for the treatment of HFpEF, but the mechanism of SGLT2i to prevent and treat cardiac remodeling and dysfunction is currently unknown, hindering the understanding of the pathophysiology of HFpEF and the development of novel therapeutics. HFpEF model was induced by a high-fat diet (60% calories from lard) + N[w]-nitro-l-arginine methyl ester (l-NAME—0.5 g/L) (2 Hit) in male Sprague Dawley rats to effectively recapture the myriad phenotype of HFpEF. This study's results showed that administration of dapagliflozin (DAPA, SGLT2 inhibitor) significantly limited the 2-Hit–induced cardiomyocyte hypertrophy, apoptosis, inflammation, oxidative stress, and fibrosis. It also improved cardiac diastolic and systolic dysfunction in a late-stage progression of HFpEF. Mechanistically, DAPA influences energy metabolism associated with fatty acid intake and mitochondrial dysfunction in HFpEF by increasing β-hydroxybutyric acid (β-OHB) levels, directing the activation of citrate synthase, reducing acetyl coenzyme A (acetyl-CoA) pools, modulating adenosine 5′-triphosphate production, and increasing the expression of mitochondrial oxidative phosphorylation system complexes I-V. In addition, following clinical DAPA therapy, the blood levels of β-OHB and citrate synthase increased and the levels of acetyl-CoA in the blood of HFpEF patients decreased. SGLT2i plays a beneficial role in the prevention and treatment of cardiac remodeling and dysfunction in HFpEF model by attenuating cardiometabolic dysregulation.
Isolated Congenital Lower Limb Lipoatrophy: A Case Report and Literature Review
Authors: Alhusain Abdullah M. , Alrodiman Osama A. , Alfaqeeh Faisal A. , Alissa Sami I.
Published: August 2023

Lipoatrophy and lipodystrophy can often be used interchangeably in the literature. However, there are some key differences. Inflammation plays a preliminary role in subcutaneous adipose tissue (SAT) loss in lipoatrophy, whereas lipodystrophy does not. There are acquired causes of SAT loss such as injurious stimuli (ie, drug injections), panniculitis, or even microtrauma. Moreover, there are congenital causes such as familial partial lipodystrophy, which follows a more localized pathology, and congenital generalized lipodystrophy, which follow a diffuse spread of SAT loss. These etiologies are further subdivided based on the mutations and clinical presentations. We present a case of a 12-year-old girl with unilateral left lower limb SAT loss since birth, without any signs of inflammation. Therefore, a diagnosis of familial partial lipodystrophy was suspected. However, genetic testing appeared unremarkable. The patient is set for conservative therapy until late adolescence for possible fat grafting.
Clinical Manifestations and Prognosis of Embolism Caused by Filler Injection in Different Facial Regions
Authors: Zhuang Jun , Zheng Qiaoyuan , Su Xueshang , Jiang Liya , Hu Jintian
Published: August 2023

Background:

Embolism is a serious complication after facial filling, with a usually poor prognosis of the symptoms after embolism. The authors systematically reviewed reported cases of facial vascular embolism, explored the relationship between the location and material used for facial filling and occurrence of vascular embolism, and assessed the prognosis of complications after vascular embolism.

Methods:

This study provides a systematic review of published cases of vascular embolism after facial filling. A summary of the filling materials and filling sites for each case, the adverse reactions and embolized blood vessels, a recording of the time when each patient experienced adverse reactions and started treatment, and a presentation of their prognosis are provided.

Results:

The frontal, eyebrow, and nose are common filling sites causing facial embolism. The main clinical manifestations after embolism were visual impairment, skin necrosis, and ptosis. The prognosis of visual impairment after embolization was poor, whereas skin necrosis and ptosis generally improved after treatment.

Conclusions:

This article aimed to review the clinical manifestations, therapies, and prognosis of embolism after facial filling. A better understanding of these complications can help clinicians to detect the occurrence of complications as early as possible and give patients timely treatment.
Health and Healthcare Access for Essential, Nonessential, and Nonworkers During the COVID-19 Pandemic
Authors: Tilhou Alyssa Shell , Saloner Brendan , DeLeire Thomas , Chakraborty Susmita , Dague Laura
Published: August 2023

Objective

The aim of the study is to describe sociodemographic characteristics, healthcare access, and health status of low-income essential, nonessential, and nonworkers during the COVID-19 pandemic.

Methods

Using survey data (2020–2021) from Wisconsin Medicaid enrollees (N = 2528), we compared sociodemographics, healthcare access, and health status between essential, nonessential, and nonworkers.

Results

Essential workers had less consistent health insurance coverage and more problems paying medical bills than nonessential and nonworkers. They reported better health than nonessential and nonworkers. They reported fewer work-limiting conditions and less outpatient healthcare utilization than nonworkers but similar rates as nonessential workers. Essential workers reported masking less frequently than nonworkers but similar frequency to nonessential workers, and lower COVID-19 vaccine willingness than nonessential and nonworkers.

Conclusions

Essential workers report better health, fewer protective behaviors, and more healthcare barriers than nonessential and nonworkers. Findings indicate essential worker status may be a social determinant of health.
Do Sleep Problems Explain the Association Between Work Stress and the Trajectories of Work Ability From Midlife to Pensionable Age?
Authors: Kontturi Marika , KC Prakash , Ervasti Jenni , Pentti Jaana , Myllyntausta Saana , Karkkola Petri , Honkalampi Kirsi , Vahtera Jussi , Stenholm Sari , Virtanen Marianna
Published: August 2023

Objective

This study examined whether mid-life work stress, defined as job strain and effort-reward imbalance (ERI), predicts work ability trajectories observed 12 years preceding the individual pensionable age. In addition, the role of sleep problems as a mediator in these associations was examined.

Methods

Survey data were collected from 2707 Finnish municipal employees.

Results

Identified work ability trajectories were “stable excellent,” “stable good,” “moderate,” and “low decreasing.” Baseline job strain and ERI were associated with a greater likelihood of belonging to impaired work ability trajectories when compared with “stable good” trajectory. Baseline sleep problems explained the association of job strain by 38% and of ERI by 54%.

Conclusions

Mid-life work stress is associated with work ability in the last years preceding pensionable age. Sleep problems might be a potential mediator in these associations.
A rite of passage: The White Coat Ceremony for advanced practice registered nursing students
Authors: Estes Krista R. , Medina Rosario , Robertson Glenda , Jones Jacqueline
Published: August 2023

Since 1993, when the Gold Foundation held its first White Coat Ceremony (WCC) to highlight humanism in medicine, many health professions have launched these ceremonies. In 2021, the University of Colorado College of Nursing hosted its first WCC. Postevent, a seven-question survey was sent to all faculty, staff, and student participants. The analytic question driving this program evaluation was as follows: “What is the significance of the White Coat Ceremony to APRN students?” Quantitative data from survey items were overwhelmingly positive; qualitative analysis of open-ended survey text reinforced the central WCC concept of Being/Becoming an APRN and elicited four themes: recognition, transition, symbolism, and connection. A detailed analysis of these themes is presented.
Metformin Reduces Tumor Growth in a Murine Flank Schwannoma Model
Authors: Manickavel Sudhir , Hartman Yolanda , Burns Andrew , Lora Gonzalez Manuel A. , Warram Jason , Walsh Erika , Hunter Jacob B. , Killeen Daniel E.
Published: August 2023

Hypothesis

Metformin and aspirin reduce vestibular schwannoma (VS) growth.

Background

There have been reported associations between patients with VS prescribed metformin and decreased tumor volumetric growth. Aspirin has also been associated with decreased VS growth in animal studies.

Methods

Rat schwannoma cell lines were grown and implanted into 50 athymic nude mice. Tumors were grown to 5 mm, and then mice were injected with either low- or high-dose metformin, aspirin, or saline daily. Tumors were measured until 14 days elapsed or mice demonstrated symptoms such as ulceration, inability to walk, or passed away.

Results

There were no significant differences in day 0 tumor sizes between the control and the treatment groups (p = 0.73). In the low-dose, but not high-dose groups, day 7 volumes were significantly different for both metformin (p = 0.04) and aspirin (p = 0.02) compared with placebo. Mean tumor growth rates were 126.6 ± 65.6 mm3/day for saline compared with 73.7 ± 29.5 mm3/day for low-dose metformin (p = 0.03) and 68.7 ± 34.8 mm3/day for low-dose aspirin (p = 0.016). There were no significant differences in tumor sizes (p = 0.59) or growth rates (p = 0.75) between low-dose metformin and aspirin groups. Low-dose groups had treatment stopped at 14 days, with continued monitoring demonstrating significant increases in tumor growth off treatment for both aspirin (p = 0.006) and metformin (p = 0.048).

Conclusions

Metformin treatment significantly reduced VS growth to a similar level as aspirin. Furthermore, when removing both metformin and aspirin treatment, tumor growth significantly increased.
Severe skin infections
Authors: Windsor Camille , Urbina Tomas , de Prost Nicolas
Published: August 2023

Purpose of review

The incidence of necrotizing soft-tissue infections (NSTI) has increased during recent decades. These infections are still associated with high morbidity and mortality, underlining a need for continued education of the medical community. This review will focus on practical approaches to management of NSTI focusing on antibiotic therapies and optimizing the management of group A streptococcus (GAS)-associated NSTIs.

Recent findings

Antibiotic therapy for NSTI patients faces several challenges as the rapid progression of NSTIs mandates broad-spectrum agents with bactericidal action. Current recommendations support using clindamycin in combination with penicillin in case of GAS-documented NSTIs. Linezolide could be an alternative in case of clindamycin resistance.

Reducing the time to diagnosis and first surgical debridement, initiating early broad-spectrum antibiotics and early referral to specialized centres are the key modifiable factors that may impact the prognosis of NSTIs. Causative organisms vary widely according to the topography of the infection, underlying conditions, and geographic location. Approximately one third of NSTIs are monomicrobial, involving mainly GAS or Staphylococcus aureus. Data for antibiotic treatment specifically for necrotizing soft-tissue infections are scarce, with guidelines mainly based on expert consensus.
Optimal drug therapy for Staphylococcus aureus bacteraemia in adults
Authors: Legg Amy , Davis Joshua S. , Roberts Jason A.
Published: August 2023

Purpose of review

Staphylococcus aureus is a significant human pathogen, causing a variety of infections, from skin and soft tissue infections to endocarditis, bone and joint infections and deep tissue abscesses. Mortality from S. aureus bacteraemia remains high, without major therapeutic advances in recent decades.

Recent findings

In recent years, optimized dosing of antibiotics is increasingly being recognized as a cornerstone of management for severe infections including S. aureus bacteraemia. This comprehensive review details the pharmacokinetics/pharmacodynamics (PK/PD) targets for commonly used antistaphylococcal antibiotics and the doses predicted to achieve them in clinical practice. Recent advances in dosing of teicoplanin and use of cefazolin in CNS infections and findings from combination therapy studies are discussed. Drug exposure relationships related to toxicity are also detailed.

This review details the different PK/PD targets for drugs used to treat S. aureus bacteraemia and how to apply them in various scenarios. The drug doses that achieve them, and the risks of toxicity are also provided.
Disparities among patients with respiratory failure
Authors: Blank Jessica A. , Armstrong-Hough Mari , Valley Thomas S.
Published: August 2023

Purpose of review

Disparities are common within healthcare, and critical illness is no exception. This review summarizes recent literature on health disparities within respiratory failure, focusing on race, ethnicity, socioeconomic status, and sex.

Recent findings

Current evidence indicates that Black patients have higher incidence of respiratory failure, while the relationships among race, ethnicity, and mortality remains unclear. There has been renewed interest in medical device bias, specifically pulse oximetry, for which data demonstrate patients with darker skin tones may be at risk for undetected hypoxemia and worse outcomes. Lower socioeconomic status is associated with higher mortality, and respiratory failure can potentiate socioeconomic inequities via illness-related financial toxicity. Literature on sex-based disparities is limited; however, evidence suggests males receive more invasive care, including mechanical ventilation.

Most studies focused on disparities in incidence and mortality associated with respiratory failure, but few relied on granular clinical data of patients from diverse backgrounds. Future studies should evaluate processes of care for respiratory failure that may mechanistically contribute to disparities in order to develop interventions that improve outcomes.
Co-morbid insomnia and sleep apnea (COMISA): recent research and future directions
Authors: Sweetman Alexander , Osman Amal , Lack Leon , Crawford Megan , Wallace Douglas
Published: August 2023

Purpose of review

Insomnia and obstructive sleep apnea have previously been viewed as completely independent conditions. However, there is now increasing recognition that insomnia and sleep apnea frequently co-occur. Co-morbid insomnia and sleep apnea (COMISA) is a highly prevalent condition that is associated with impairment of sleep, daytime function, mental health and physical health outcomes, and mortality risk. This review aims to provide an update on COMISA prevalence, consequences, treatment approaches, and future research directions.

Recent findings

People with COMISA experience worse sleep, mental health, physical health, quality of life and longevity compared to people with neither condition, and often compared to those with insomnia alone and sleep apnea alone. Emerging evidence suggests that cognitive behavioral therapy for insomnia is an effective treatment in the presence of treated and untreated sleep apnea, that may also improve manifestations and subsequent management of sleep apnea. Future research is required to understand the etiology of COMISA, and to develop and implement tailored treatment approaches.

It is important for sleep and respiratory technicians, researchers and clinicians to be aware of the high co-morbidity rates, consequences, and treatment requirements of patients with co-morbid insomnia and sleep apnea.
A convolutional neural network-based system to estimate the arterial plasma radioactivity curve in 18F-FDG dynamic brain PET study
Authors: Kawauchi Keisuke , Saito Mui , Nishigami Kentaro , Katoh Chietsugu
Published: August 2023

Purpose

Quantitative images of metabolic activity can be derived through dynamic PET. However, the conventional approach necessitates invasive blood sampling to acquire the input function, thus limiting its noninvasive nature. The aim of this study was to devise a system based on convolutional neural network (CNN) capable of estimating the time-radioactivity curve of arterial plasma and accurately quantify the cerebral metabolic rate of glucose (CMRGlc) directly from PET data, thereby eliminating the requirement for invasive sampling.

Methods

This retrospective investigation analyzed 29 patients with neurological disorders who underwent comprehensive whole-body 18F-FDG-PET/CT examinations. Each patient received an intravenous infusion of 185 MBq of 18F-FDG, followed by dynamic PET data acquisition and arterial blood sampling. A CNN architecture was developed to accurately estimate the time-radioactivity curve of arterial plasma.

Results

The CNN estimated the time-radioactivity curve using the leave-one-out technique. In all cases, there was at least one frame with a prediction error within 10% in at least one frame. Furthermore, the correlation coefficient between CMRGlc obtained from the sampled blood and CNN yielded a highly significant value of 0.99.

Conclusion

The time-radioactivity curve of arterial plasma and CMRGlc was determined from 18F-FDG dynamic brain PET data using a CNN. The utilization of CNN has facilitated noninvasive measurements of input functions from dynamic PET data. This method can be applied to various forms of quantitative analysis of dynamic medical image data.
Use of genomic markers to improve epidemiologic and clinical research in urology
Authors: Cancel-Tassin Géraldine , Koutros Stella
Published: August 2023

Purpose of review

Urologic cancers result from the appearance of genomic alterations in the target organ due to the combination of genetic and environmental factors. Knowledge of the genomic markers involved in their etiology and mechanisms for their development continue to progress. This reviewed provides an update on recent genomic studies that have informed epidemiologic and clinical research in urology.

Recent findings

Inherited variations are an established risk factor for urologic cancers with significant estimates of heritability for prostate, kidney, and bladder cancer. The roles of both rare germline variants, identified from family-based studies, and common variants, identified from genome-wide association studies, have provided important information about the genetic architecture for urologic cancers. Large-scale analyses of tumors have generated genomic, epigenomic, transcriptomic, and proteomic data that have also provided novel insights into etiology and mechanisms. These tumors characteristics, along with the associated tumor microenvironment, have attempted to provide more accurate risk stratification, prognosis of disease and therapeutic management.

Genomic studies of inherited and acquired variation are changing the landscape of our understanding of the causes of urologic cancers and providing important translational insights for their management. Their use in epidemiologic and clinical studies is thus essential.
Lack of association of the alpha-ketoglutarate-dependent dioxygenase (FTO) gene polymorphisms with pulmonary tuberculosis risk: a systematic review and meta-analysis
Authors: Lamichhane Pratik , Qureshi Maha Rahim , Islam Nabila , Sanipini Sailakshmn , Gopaul Vakeanand , Razick Shakira Dilfazeer , Agrawal Anushka , Falfan-Valencia Ramces
Published: August 2023

Objective:

Our meta-analysis aims to explore the association of two single nucleotide variants; rs9939609 and rs8050136, within the FTO gene with risk of pulmonary tuberculosis (PTB).

Methods:

The association of two single nucleotide variants with PTB in three genetic models was evaluated using pooled odds ratios (ORs) with 95% CIs.

Results:

No significant association was observed between the rs9939609 polymorphism and PTB when assuming an allelic model (OR: 1.10; 95% CI: 0.85–1.41; P=0.47; I2 = 64.98%), a recessive model (OR: 2.04; 95% CI: 0.87–4.77; P=0.10; I2 = 67.18%), or a dominant model (OR: 0.96; 95% CI: 0.83–1.11; P=0.56; I2 = 27.45%). Likewise, no association was observed between rs8050136 polymorphism and PTB when assuming allelic model (OR: 1.17; 95% CI: 0.87–1.58; P=0.31; I2 = 64.20%) or recessive model (OR: 1.04; 95% CI: 0.32–3.38; P=0.95; I2 = 68.82%) or dominant model (OR: 1.22; 95% CI: 0.87–1.71; P=0.26; I2 = 58.69%).

Conclusion:

There might be no association between the rs9939609 and rs8050136 variants in the FTO gene, and the risk of PTB.
Association of vitamin D and functional dyspepsia: a case-control study
Authors: Das Dhriti Sundar , Saharia Gautom Kumar , Panigrahi Manas Kumar , Sahoo Debananda
Published: August 2023

Background:

Vitamin D plays a key role in responses of brain-gut axis. It has been suggested that functional dyspepsia (FD) may be associated with decreased levels of vitamin D. Hence this study wished to find the association between vitamin D in patients with FD.

Materials and methods:

This case-control study was done at a tertiary care hospital with 150 cases and 150 controls. FD was diagnosed by the ROME IV criteria. Demographic profile and serum vitamin D levels including Perceived Stress Score (PSS) and salivary amylase were determined for both cases and controls.

Results:

Majority of the FD cases were males (57.3%). Post-prandial distress syndrome represented the major type of FD cases (69.3%). A higher mean BMI was found among the control group (23.2 vs. 21.2, P<0.05) and higher percentage of obese individuals in the control group (42.7% vs. 29.3%, P= 0.05). Majority of the cases are from rural background (89.3% vs. 74%, P<0.001). Comparison of PSS showed that cases had significantly higher grades of PSS than control (P<0.001). However, no significant association was found in the levels of salivary amylase between the groups (P=0.728). Hypovitaminosis D (<30 ng/ml) was found significantly more among cases than controls (73.3% vs. 60%; P<0.05) with an odds ratio of 1.833 (CI 95%= 1.126–2.985). After adjustment of age, place of residence and BMI, vitamin D levels were significantly associated with FD in the regression analysis.

Conclusion:

This study shows significant association of vitamin D deficiency in FD patients. It also opens up new avenues for further research into the role of vitamin D supplementation to further improve the management of such cases.
Severe acute organophosphate poisoning managed with 2-month prolonged atropine therapy: a case report
Authors: Bashyal Bibhav , Yadav Alisha , Deo Anand K. , Kharel Kirti K. , Kharel Deepshikha , Panthi Bishal
Published: August 2023

Introduction and Importance:

Organophosphate (OP) poisoning is a common and potentially fatal condition that requires prompt and aggressive treatment with atropine, oximes, and supportive care. We report a rare case of OP poisoning that needed high doses of atropine and intensive care for 60 days.

Case Presentation:

A 39-year-old male ingested 200 ml of chlorpyrifos, an OP compound, and presented with vomiting and epigastric pain. He received an initial dose of atropine of 60 ml (36 mg, 1 ml=0.6 mg), followed by an infusion of 16 ml/h (9.6 mg/h). He developed hypoxia, cardiac arrest, delirium, fever, and persistent bronchorrhea. He was intubated, resuscitated, and transferred to ICU, where he continued showing signs of OP excess and therefore, he received up to 170 ml/h (102 mg/h) of atropine infusion, along with triple inotropes and sedation. He underwent tracheostomy and gradual weaning of atropine. He recovered completely and was discharged in stable condition.

Clinical Discussion:

This case demonstrates the need for prolonged monitoring of patients with OP poisoning wherein the patient can develop signs of OP excess even after initial atropinization, the effectiveness of multiple doses of atropine in OP poisoning, and the importance of monitoring for complications associated with a prolonged hospital stay. It also shows the potential need for prolonged atropine therapy and intensive care in OP poisoning.

Conclusion:

OP poisoning can be life-threatening and requires early and aggressive treatment with atropine, oximes, and supportive care. Clinicians should be aware of the potential need for prolonged atropine therapy in OP poisoning cases to improve the chances of survival.
Maximizing Nurse Scientist Role Potential in Health Care Organizations
Authors: Hampton Michelle DeCoux , Williams Michelle Y.
Published: August 2023

Before Magnet designation, nurse scientists functioned primarily in academia. The Magnet model's emphasis on new knowledge required that health care organizations demonstrate knowledge generation to achieve and sustain designation. The nurse scientist role definition and function within health care organizations continues to evolve, which contributes to a lack of clarity about who and how nurses generate new knowledge. The purpose of this scoping review was to (1) identify nurse scientist role components in the context of 2 theoretical models (Thompson's Knowledge Brokering Model and Edward's Research Appreciation, Accessibility, and Application Model), (2) explore the strengths and barriers associated with existing nurse scientist practice models in US health care organizations, and (3) describe a unique, expanded practice model applied within Stanford Health Care's Office of Research and its implications for building new knowledge and innovation capacity with recommendations for ongoing role development.
Wake-up Call
Authors: Imes Christopher C. , Tucker Sharon J. , Trinkoff Alison M. , Chasens Eileen R. , Weinstein Sharon M. , Dunbar-Jacob Jacqueline , Patrician Patricia A. , Redeker Nancy S. , Baldwin Carol M.
Published: August 2023

The purpose of this mini review is to (1) summarize the findings on the impact of night shift on nurses' health and wellness, patient and public safety, and implications on organizational costs and (2) provide strategies to promote night shift nurses' health and improve organizational costs. The night shift, compared with day shift, results in poorer physical and mental health through its adverse effects on sleep, circadian rhythms, and dietary and beverage consumption, along with impaired cognitive function that increases nurse errors. Nurse administrators and health care organizations have opportunities to improve nurse and patient safety on night shifts. Low-, moderate-, and higher-cost measures that promote night nurses' health and well-being can help mitigate these negative outcomes. The provided individual and organizational recommendations and innovations support night shift nurses' health, patient and public safety, and organizational success.
Condoms on Campus: Understanding College Students’ Embarrassment, Self-Efficacy, and Beliefs about Distribution Programs
Authors: Oswalt Sara B. , Butler Scott , Sundstrom Beth , Hughes Charmayne M. L. , Petonic Robbins Charlotte
Published: August 2023

Background

Condom distribution programs are a structural level intervention implemented on college campuses to reduce STIs and unplanned pregnancies. Understanding students’ beliefs about these programs and attitudes that can affect condom use is critical.

Methods

Students at six different universities (n = 2,809) completed items related to beliefs about campus condom distribution programs and their personal condom embarrassment and condom self-efficacy levels. Surveys were completed both in classroom and online. T-tests and ANOVA were used to examine differences based on demographics. Logistic regression was used to examine predictors of condom use.

Results

College students support the distribution of condoms on campus (97.4%) but express moderate levels of embarrassment in condom acquisition and possession (Mean = 19.37). Lower rates of embarrassment were reported for condom negotiation (Mean = 9.13) and actual condom use (Mean = 8.48). Lower overall rates of embarrassment were reported by condom users, men and individuals in relationships compared to non-condom users, women and single individuals. Heterosexual students were more embarrassed than bisexual students about acquiring condoms and negotiating condom use. Condom users, men, and individuals in relationships had higher rates of condom self-efficacy compared to non-users, women and single students. There were no differences in self-efficacy based on sexual orientation. Embarrassment about acquiring and actual use of condoms, condom self-efficacy and demographics were all significant predictors of condom use.

Conclusions

Campus condom distribution programs are supported by college students. Interventions to address embarrassment and increase condom self-efficacy need to be tailored to different students based on gender, experience with condoms, and relationship status.
Potential Predictors of Severe and Recurrent Pancreatitis in Children
Authors: Kim Hyun Jin
Published: August 2023

Objectives

Severe pancreatitis often requires intensive care; therefore, early detection is important. This study aimed to evaluate the possible predictors of pancreatitis severity in children. Furthermore, we evaluated the prevalence of pancreatitis recurrence and related factors.

Methods

We retrospectively analyzed the medical records of patients aged younger than 18 years who were diagnosed with acute pancreatitis between January 2017 and June 2022. Acute pancreatitis was diagnosed and classified based on the revised Atlanta criteria.

Results

A total of 64 patients were enrolled, and severe pancreatitis was observed in 10 (15.6%) patients. Patients with severe pancreatitis were younger and had higher C-reactive protein levels than those with mild pancreatitis. The areas under the receiver operating characteristic curves of C-reactive protein levels at admission and 48 hours after diagnosis were 0.612 (95% confidence interval, 0.379–0.844) and 0.873 (95% confidence interval, 0.537–0.983), respectively. Fourteen patients (21.9%) experienced further episodes of recurrent pancreatitis. Patients with recurrent pancreatitis were older (13.7 vs 11.4 years, P = 0.022) and prominently boys (85.7 vs 52%, P = 0.022) compared with those without recurrence. Obesity was observed in 4 (0.6%) patients, which was confirmed in all recurrence groups and was statistically significant.

Conclusions

This study demonstrated the feasibility of C-reactive protein in the early risk assessment of patients with acute pancreatitis and highlighted the potential risk of recurrence in patients with obesity.
Value of Magnetic Resonance Imaging for Skeletal Bone Age Assessment in Healthy Male Children
Authors: Basten Lajos M. , Leyhr Daniel , Murr Dennis , Hauser Thomas , Lüdin Dennis , Romann Michael , Höner Oliver , Fischer Sebastian , Gruber-Rouh Tatjana , Eichler Katrin
Published: August 2023

Background:

Skeletal bone age assessment for medical reasons is usually performed by conventional x-ray with use of ionizing radiation. Few pilot studies have shown the possible use of magnetic resonance imaging (MRI).

Purpose:

To comprehensively evaluate feasibility and value of MRI for skeletal bone age (SBA) assessment in healthy male children.

Materials and Methods:

In this prospective cross-sectional study, 63 male soccer athletes with mean age of 12.35 ± 1.1 years were examined. All participants underwent 3.0 Tesla MRI with coronal T1-weighted turbo spin echo (TSE), coronal proton density (PD)–weighted turbo spin echo (TSE), and T1-weighted three-dimensional (3D) volume interpolated breath-hold examination (VIBE) sequence. Subsequently, SBA was assessed by 3 independent blinded radiologists with different levels of experience using the common Greulich-Pyle (GP) atlas and the Tanner-Whitehouse (TW2) method.

Results:

In a mean total acquisition time of 5:04 ± 0:47 min, MR image quality was sufficient in all cases. MRI appraisal was significantly faster (P < 0.0001) by GP with mean duration of 1:22 ± 0:08 min vs. 7:39 ± 0:28 min by TW. SBA assessment by GP resulted in mean age of 12.8 ± 1.2 years, by TW 13.0 ± 1.4 years. Interrater reliabilities were excellent for both GP (ICC = 0.912 (95% confidence interval [CI] = 0.868–0.944) and TW (ICC = 0.988 (95% CI = 0.980–0.992) and showed statistical significance (P < 0.001). Subdivided, for GP, ICCs were 0.822 (95% CI = 0.680–0.907) and 0.843 (95% CI = 0.713–0.919) in Under 12 and Under 14 group. For TW, ICCs were 0.978 (95% CI = 0.958–0.989) in Under 12 and 0.979 (95% CI = 0.961–0.989) in Under 14 group.

Conclusion:

MRI is a clinically feasible, rapidly evaluable method to assess skeletal bone age of healthy male children. Using the Greulich-Pyle (GP) atlas or the Tanner-Whitehouse (TW2) method, reliable results are obtained independent of the radiologist's experience level.
Clinical Analysis of Patients who Underwent Reoperation After Orthognathic Surgery: A 14-Year Retrospective Study
Authors: Jaiswal M. Shriya , Hwang Dae-Seok
Published: August 2023

Purpose:

The purpose of this study was to analyze the patients clinically who underwent reoperation after certain Orthognathic procedures, and to assess the reoperation rate. Furthermore, the authors also evaluated the incidence of intraoperative and postoperative complications that led to the need for reoperation.

Methods:

Total 526 patients were selected who underwent Orthognathic surgery between July 2008 and February 2022 at the Department of Oral and Maxillofacial Surgery in Pusan National University Dental Hospital by single surgeon. All the patients information were extracted from electronic database of our university. Demographic, radiologic, intraoperative, and postoperative data were recorded and compiled.

Results:

Out of 526 patients, 265 (50.3%) were males and 261 (49.6%) were females. The total number of patients who showed complication is 89 (16.9%) and the patients who underwent reoperation are 17 (3.2%). The common complications that occurred were postoperative sensory disturbance (31; 5.8%), unwanted fractures (17; 3.2%), intraoperative nerve injury (11; 2%), wound dehiscence (11; 2%), infection (10; 1.9%), tooth injury (2; 0.3%), and others (18; 3.4%). The serious complications that led to reoperation include severe bleeding (6; 1.1%), unesthetic results (5; 0.9%), non-union of maxilla (4; 0.7%), and failed osteosynthesis (2; 0.3%). After 2018, all the orthognathic surgeries were performed with the help of virtual surgical planning. After application of virtual surgical planning, the number of patients with complications statistically decreased.

Conclusion:

The present study showed that the reoperation rate after orthognathic surgery was low, this rate was more decreased after applying 3-dimensional virtual surgery and 3-dimensional printed plate, especially in unesthetic cases.
Aesthetic Reconstruction of an Old Burr Hole Defect Using a Cancellous Bone Chip and a Porous Polyethylene Implant
Authors: Lee Jun Yong , Jeon Hui Hyung , Rha Eun Young
Published: August 2023

Burr hole trephination is a minimally invasive procedure but can leave a depressed scar at the surgical site. Various materials have been studied to fill such defects; however, to the best of our knowledge, there are no reports of reconstructing old, depressed scars from burr hole surgery. This report presents a patient with depressed scarring near the anterior hairline of the frontal bone on both sides due to burr hole trephination for a subdural hematoma 27 years prior. Computed tomography scans revealed bony defects under the scar. Reconstruction of the bony defect was performed by debriding the bony bed, filling it with hydrated alloplastic cancellous bone, and covering it with a porous SynPOR polyethylene titanium-reinforced implant. During 1 year of follow-up, the reconstruction was maintained without complications. The patient was satisfied with the esthetic outcome. Thus, old bony defects can be repaired using the appropriate materials and techniques.
Acellular Dermal Matrix, Osseoplastic Flap, and Transnasal Endoscopic Approach for Frontal Mucocele
Authors: Orozco-Fernández Martin , Mejía Juan Pablo , López Juan Pablo , Vanegas Marcela , Orostegui-Hernández Victor
Published: August 2023

Purpouse:

The primary objective of this study is to suggest the use of acellular dermal matrix through an osteoplastic flap and transnasal endoscopic treatment for the management of frontal mucoceles. The secondary objective is to propose the characteristics to choose this approach.

Methods:

A retrospective cohort study was carried out on patients with frontal mucoceles of different etiologies where an osteoplastic flap was made to address the sinus and subsequently obliterated with acellular dermal matrix.

Results:

A cohort of 11 patients were included in the study, 6 (67%) were female and 5 (56%) were male, with a mean age of 56 years (range 35–71). The majority of patients (73%) with a history of trauma and all the patients were treated with frontal osteoplastic flap and obliteration with acellular dermal matrix. No evidence of recurrence in a follow-up period with a mean of 18 months and a low rate of complications.

Conclusions:

The frontal osteoplastic flap and obliteration with acellular dermal matrix is a simple and safe technique to perform with low morbidity. Also, an orbital reconstruction can be performed simultaneously.
Immediate Free Fibula Flap After Maxillectomy With Simultaneous Full-arch Dental Implant-Supported Prosthetic Rehabilitation of the Midface and Mandible: The “Super Reconstruction Concept”
Authors: Frias Vladimir , Al Afif Ayham , Markiewicz Michael R.
Published: August 2023

Immediate reconstruction and dental rehabilitation for ablative defects of the head and neck in one surgery is now a commonly used technique among reconstructive surgeons. Often patients are edentulous or partially edentulous in the jaw opposing that with pathology. In this case, only rehabilitating the dental arch affected by pathology would not render the patient with a functional occlusion. We introduce the “super reconstruction” concept which includes not only rehabilitating the dental arch affected by pathology but also the opposing arch, giving the patient a fully functional occlusion at the time of ablative surgery. This concept is described through a case of a patient with a T4aN0M0 squamous cell carcinoma of the maxilla who underwent total maxillectomy, immediate fibula flap reconstruction of the maxilla with, and full arch dental implant placement into the maxilla and opposing mandible with prosthetic rehabilitation.
Establishment of a Three-Dimensional Finite Element Model and Mechanical Analysis of the Upper Lip Flap With Secondary Cleft Lip Deformity
Authors: Liang Hao , Li Haidong
Published: August 2023

Cleft lip secondary deformity is a common oral and maxillofacial deformity, usually accompanied by the upper lip and nasal cleft. The main treatment method for cleft lip secondary deformity is surgical repair. Among them, upper lip flap repair is a common method; the principle is to transplant the healthy tissue to the lesion site to achieve the purpose of repair. However, during the surgical process, each key point’s stress distribution and strain conditions are quite different. Therefore, special attention should be paid to the mechanical properties of each key point during the repair operation to ensure the surgical effect. This paper aims to establish a 3-dimensional finite element model and perform finite element analysis to simulate the mechanical properties and key point displacement of the upper lip flap repair operation for cleft lip secondary deformity to improve the operation’s success rate and safety.
Translation, Transcultural Adaptation, and Validation of the Hebrew Language Version of the Orthognathic Quality of Life Questionnaire for the Assessment of Quality of Life in Orthognathic Patients
Authors: Dobriyan Alex , Shavit Idan , Yavnai Nirit , Akerman Eyal , Hirschorn Ariel , Yahalom Ran , Yoffe Tal
Published: August 2023

Introduction:

Dentofacial deformities impose a negative impact on quality of life (QOL). Orthognathic surgery is the main pillar of treatment for these conditions and has proven its impact on the improvement of the functional and psychosocial aspects of QOL. The Orthognathic Quality of Life Questionnaire (OQLQ), developed by Cunningham and colleagues, is a well-established instrument for assessing QOL in patients with dentofacial deformities.

Objective:

The aim of this study was to perform a translation, transcultural adaptation, and validation of a Hebrew version of the OQLQ.

Methods:

Transcultural adaptation was done following guidelines proposed by Beaton and colleagues resulting in a pilot study conducted on 20 patients undergoing orthognathic surgery. Internal consistency, reliability, and sensitivity were evaluated by means of Cronbach alpha, intraclass correlation coefficient (test-retest), and Wilcoxon test, respectively. Validity was assessed by comparing the OQLQ with the Hebrew version of the Oral Health Impact Scale-14 (Oral Health Impact Profile Scale-14) using the Spearman correlation test.

Results:

Internal consistency showed a good correlation between domains and excellent test-retest reliability. Sensitivity to change was statistically significant in all but 3 questions. The Hebrew version of the OQLQ exhibited a strong correlation with Oral Health Impact Profile Scale-14 in total score and moderate to high correlations among domains.

Conclusion:

The Hebrew version of the OQLQ is a valid and reliable and specific instrument to measure QOL for Hebrew-speaking patients undergoing orthognathic surgery.
External Ear Anthropometry of Healthy Turkish Young Adults
Authors: Bahşi İlhan , Orhan Mustafa , Kervancioğlu Piraye , Karatepe Şeyma , Sayin Semih
Published: August 2023

Purpose:

The aim of this study was to determine the external ear values in Turkish young adults with 2-dimensional photogrammetry.

Methods:

One hundred males and 100 females aged between 18 and 25 years were included in the study. Individuals were photographed from both sides. Ear length (superaurel-subaurel, spa-sba), ear width (preaurel-postaurel, pra-pa), and the angle between the vertical axis of the auricle and the line between spa and sba (ear incline angle, eia) were measured in these photographs. Also, auricular index (pra-pa/spa-sba×100) was calculated.

Results:

The average values of the spa-sba, pra-pa, eia, and auricular index were found as 65.46±4.68 mm, 37.89±3.61 mm, 19.40±4.83 degrees, and 57.93±4.53 in males and 60.90±5.35 mm, 35.62±3.69 mm, 17.95±4.86 degrees, and 58.65±5.29 in females, respectively. While the values of spa-sba (P=0.001 for the right side and P=0.001 for the left side), pra-pa (P=0.001 for the right side and P=0.001 for the left side), and eia (P=0.024 for the right side and P=0.041 for the left side) were statistically higher for males than females, there was no statistically significant difference between the sex and the auricular index (P=0.404 for the right side and P=0.955 for the left side). Besides, there was no statistically significant difference between the sides for these 4 parameters (P=0.760, 0.409, 0.225, and 0.521, respectively).

Conclusion:

The authors believe that the results obtained for Turkish young adults can be used as reference values, which can be used in the diagnosis, follow, or surgical treatment of many diseases, forensic procedures, and planning esthetic surgery procedures.