bluuebunny/crossref_metadata_2025 huggingface dataset:
Decoding Vaping: Empowering Youth Through Media Literacy Based E-cigarette Educational Program
Authors: Michaud Tzeyu L , Tamrakar Niran , Samson Kaeli , Dai Hongying Daisy
Published: September 2024

Introduction

The E-cigarette industry’s marketing and social media efforts have promoted adolescent vaping. We developed and pilot-tested an anti-vaping media literary program—MediaSense.

Aims and Methods

In addition to employing the Community-Based Participatory Research approach for program development, we applied a prospective, interventional, and single-arm design to assess the impact of MediaSense among students from five middle and high schools. Data were collected through REDCap surveys administered before and after the intervention. We performed generalized linear mixed models and median analysis to evaluate changes in vaping media literacy (ie, Authors and Audiences [vAA], Messages and Meanings [vMM], and Representation and Reality [vRR]), knowledge, harm perception, and susceptibility to e-cigarette use before and after the intervention.

Results

A total of 384 students aged 11–18 years completed the pre–post survey assessment. After the intervention, students exhibited significantly improved vaping media literacy across all three domains (vAA, fold change [FC] = 150%, p < .0001; vMM, FC = 143%, p < .0001; vRR, FC = 133%, p = .0007). The intervention was associated with a reduction of vaping susceptibility (adjusted odds ratio [AOR] = 0.7, p = .04) and improvement in harm perception (AOR = 1.6, p = .009), knowledge of flavored e-cigarettes (AOR = 4.4, p < .0001) and Tobacco 21 policy (AOR = 6.2, p < .0001). Further mediation analysis unveiled the pathway of the intervention on reduction of vaping susceptibility through media literacy (βindirect = −0.03, p = .003) and harm perception enhancement (βindirect = −0.02, p = .03).

Conclusions

The MediaSense program showed promise in vaping prevention among adolescents by reducing vaping susceptibility. Comprehensive vaping media literacy education, especially interventions aimed at decoding misleading marketing information and addressing emerging marketing themes, provides valuable evidence in curbing adolescent vaping.

Implications

MediaSense (Media Education for Sensible Evaluation and Nurturing Substance-free Experiences) represents a promising e-cigarette education program designed for adolescent vaping prevention. The findings of this study highlight the positive impact of the program on media literacy, harm perception, and knowledge of tobacco control policies.
What is the Relationship Between Raising the Minimum Legal Sales Age of Tobacco Above 20 and Cigarette Smoking? A Systematic Review
Authors: Davies Nathan , Bogdanovica Ilze , McGill Shaun , Murray Rachael L
Published: September 2024

Introduction

There is considerable interest in raising the age of sale of tobacco above the conventional age of 18 years. We systematically reviewed whether raising the minimum legal sales age of tobacco (MLSA) to 20 or above is associated with a reduced prevalence of smoking compared to an MLSA set at 18 or below.

Aims and Methods

Following a preregistered protocol on PROSPERO (ref: CRD42022347604), six databases of peer-reviewed journals were searched from January 2015 to April 2024. Backward and forward reference searching was conducted. Included studies assessed the association between MLSAs ≥20 with cigarette smoking or cigarette sales for those aged 11–20 years. Assessments on e-cigarettes were excluded. Pairs of reviewers independently extracted study data. We used ROBINS-I to assess the risk of bias and GRADE to assess the quality of evidence. Findings were also synthesized narratively.

Results

Twenty-three studies were reviewed and 34 estimates of association were extracted. All extracted studies related to Tobacco 21 laws in the United States. Moderate quality evidence was found for reduced cigarette sales, moderate quality evidence was found for reduced current smoking for 18–20-year-olds, and low-quality evidence was found for reduced current smoking for 11–17-year-olds. The positive association was stronger for those with lower education. Study bias was variable.

Conclusions

There is moderate quality evidence that Tobacco 21 can reduce overall cigarette sales and current cigarette smoking amongst those aged 18–20 years. It has the potential to reduce health inequalities. Research in settings other than the United States is required.

Implications

This systematic review on raising the minimum legal sale age of tobacco to 20 or above demonstrates there is moderate quality evidence that such laws reduce cigarette sales and moderate quality evidence they reduce smoking prevalence amongst those aged 18–20 years compared to a minimum legal sale age of 18 years or below. The research highlights potential benefits in reducing health inequalities, especially for individuals from lower educational backgrounds. Studies are limited to the United States, highlighting a need for more global research to assess the impact of these policies in other settings.
Smoking Uptake Among Adolescents in Social Housing Australia
Authors: Singh Ankur , Martino Erika , Mansour Adelle , Bentley Rebecca
Published: September 2024

Introduction

Australia’s limited social housing has created geographically concentrated locales of poverty with high smoking rates. The impact of social housing on smoking initiation among adolescent residents is unknown, despite adolescence being a critical period for smoking prevention. We examine the relationship between social housing residency and smoking initiation among adolescents to quantify the likelihood of smoking uptake among social housing residents compared to a similar cohort in other tenures, accounting for socioeconomic factors and household exposure to smoking.

Methods

We analyzed data on 15- to 18-year-old adolescents (n = 3132) from the Household, Income and Labour Dynamics in Australia survey (2001–2019). We applied inverse probability treatment weights to maximize exchangeability between social housing tenants and their counterparts in other tenures. We quantified the risk of smoking 5 years after exposure measurement among those in social housing on both an absolute and relative scale. Baseline covariates included household income, age at study entry, sex, family type, smoking at baseline, highest household education, and household exposure to smoking.

Results

Adolescent residents in social housing had a 17% greater risk of smoking 5 years after baseline measurement than their counterparts in all other tenures (Average Treatment Effect (ATE): 0.165, 95% confidence interval [CI] = 0.02 to 0.31). On the relative scale, those in social housing had 1.80 times (95% CI = 0.95 to 2.66) higher risk of being a smoker than those in other tenures.

Conclusions

Adolescents residing in social housing have a higher risk of becoming smokers as young adults than their counterparts in other tenures, irrespective of smoking exposure in their own homes.

Implications

This study investigates the impact of social housing on smoking initiation among adolescents, revealing that those residing in social housing have a higher risk of becoming smokers in young adulthood, independent of smoking exposure at home. The research highlights the contribution of social housing to ongoing disparities in smoking rates in Australia and emphasizes the need to further understand and review social housing provision from the perspective of its consequences on health. Moreover, the results advocate for comprehensive policies that extend beyond individualized harm reduction strategies to promote social inclusion and address health inequalities associated with smoking in adolescents.
Patterns of Blunt and Cigar Use in the United States, 2015–2019
Authors: Jensen Jessica K , Ganz Ollie , Tomaino Marisa , Glasser Allison M , Sterling Kymberle , Delnevo Cristine D , Bover Manderski Michelle T
Published: September 2024

Introduction

The use of cigars for blunts (ie, cannabis rolled in cigar paper) is well documented; the prevalence of cigar and blunt use and associated characteristics are less studied.

Methods

Pooled data from the 2015–2019 National Survey on Drug Use and Health were analyzed in 2023. Respondents aged 12+ who reported past 30-day cigar use were categorized into three mutually exclusive use categories: (1) exclusively cigars, (2) exclusively blunts, and (3) both cigars and blunts. We examined associations between cigar-blunt use categories and sociodemographic characteristics.

Results

Among respondents aged 12+ who reported past 30-day cigar use, 48.6% (95% confidence interval [CI] = 47.6 to 49.6) reported exclusive cigar use; 44.3% (95% CI = 43.3 to 45.3) reported exclusive blunt use; and 7.2% (95% CI = 6.8 to 7.6) reported use of cigars and blunts. The prevalence differed by age, with exclusive blunt use most prevalent among youth (72.5% [95% CI = 70.7 to 74.3]) and young adults (62.4% [95% CI = 61.4 to 63.5]), and exclusive cigar use most prevalent among adults 26+ (61.2% [95% CI = 59.8 to 62.5]). Exclusive blunt users smoked more days in the past month (17.5; 95% CI = 16.8 to 18.2), compared to 13.8 days (95% CI = 13.2 to 14.4) for cigar and blunt users, and 7.7 days (95% CI = 7.5 to 8.0) for exclusive cigar users. There were significant differences in sociodemographic characteristics, with female (41.6%; 95% CI = 40.3 to 42.9) and Hispanic (18.2%; 95% CI = 17.3 to 19.2) participants more likely to report exclusive blunt use.

Conclusions

Exclusive blunt use was the most prevalent pattern of past 30-day cigar use among youth and young adults. Those who use cigars as blunts smoked more cigars per month, suggesting this may be an important group for education and policy efforts.

Implications

Studies that aggregate cigars and blunts into one group may limit potentially meaningful subgroup risk profiles. Additionally, when assessing cigar use, particularly among youth and young adults, it is important to consider blunt use to avoid missing youth who exclusively use cigars for blunts and may not consider blunts as cigar products. Accurate measurement may better inform tobacco and cannabis regulatory actions. Finally, given the high prevalence of blunt use among youth and young adults identified in the present study, additional education efforts may be warranted for this population to reduce long-term risks.
A Pilot Study to Test the Feasibility of a Randomized Controlled Trial of E-cigarettes as Harm Reduction Tools Among People Who Smoke and Previously Failed to Quit With Pharmacotherapy
Authors: Smith Tracy T , Ferreira Anna , Wahlquist Amy E , Cummings K Michael , Rojewski Alana M , McClure Erin A , Toll Benjamin A , Carpenter Matthew J
Published: September 2024

Introduction

We conducted a pilot study to test the feasibility of a future randomized controlled trial comparing e-cigarettes to traditional pharmacotherapy among people who smoke daily, were motivated to quit, and failed to quit within the past 5 years using pharmacotherapy.

Aims and Methods

Eligible participants were assigned to either: (1) an e-cigarette (n = 20) or (2) combination nicotine replacement therapy (NRT; patches and lozenges; n = 10). Participants received 5 weeks of product and selected a quit date 1 week later. Assessments were completed weekly, and electronic diaries were completed each day. As a pilot randomized controlled trial, outcomes focus on effect sizes and not statistical significance.

Results

Participants in the e-cigarette and NRT groups had a mean age of 51 (SD = 13) and 50 (SD = 10) years old, were 55% and 60% female, and were 15% and 0% nonWhite, respectively. At least 90% of participants completed each weekly assessment and 77% of participants completed at least 80% of daily diaries. Mean cigarettes smoked per day reduced from 18 (SD = 6.2) to 2.4 (SD = 4.4) per day in the e-cigarette group and 16.5 (SD = 8.5) to 4.9 (SD = 5.9) per day in the NRT group. Rates of biochemically confirmed 7-day point-prevalence abstinence at the end of treatment were numerically, but not statistically, higher in the e-cigarette group than the NRT group (35% vs. 10%, OR = 4.8, 95% CI = 0.5 to 46.5).

Conclusions

Among current daily cigarette smokers who have previously tried to quit and failed with standard pharmacotherapies, the provision of an e-cigarette is a feasible intervention. A larger adequately powered trial is warranted.

Implications

This pilot study suggests that e-cigarettes may serve as an acceptable harm reduction intervention for people who smoke but cannot quit smoking with traditional pharmacotherapy, however, adequately powered randomized controlled trials are needed.
Implementing Updated Intraamniotic Infection Guidelines at a Large Academic Medical Center
Authors: Smiley Casey , Rizzuto Jessica , White Nicola , Fiske Christina , Thompson Jennifer , Zhang Minhua , Ereshefsky Ben , Staub Milner
Published: September 2024

Background

Intraamniotic infection (IAI) affects 2%–5% of pregnancies, causing significant neonatal and maternal morbidity. The American College of Obstetrics and Gynecology suggests ampicillin and gentamicin as first-line IAI treatment. Due to potential drug toxicity, changes in gentamicin susceptibility cutoff points, and rising Enterobacterales gentamicin and ampicillin resistance, changes in IAI antibiotic treatment were implemented at Vanderbilt University Medical Center.

Methods

Combination ampicillin, gentamicin, and clindamycin were replaced by piperacillin-tazobactam in institutional IAI treatment. Implementation strategies included repeated education sessions to gain stakeholder trust and buy-in and changing preexisting electronic clinical decision support tools (eCDSTs) to a default selection of piperacillin-tazobactam, capitalizing on highly reliable intervention strategies of forcing function and automatization/computerization. Change in antibiotic use, measured in days of therapy (DOT)/1000 patient-days present (1000PDP) by week initiated, before and after eCDST changes, was analyzed with interrupted time series analysis. Effects on hospital length of stay, repeat antibiotics within 14 days, and 30 day readmission were evaluated using multivariable linear and logistic regression.

Results

After updated eCDST go-live, piperacillin-tazobactam use increased by 1.9 DOT/1000PDP (95% CI, 0.7 to 3.1) by week initiated, and ampicillin, gentamicin, and clindamycin use decreased by −2.5 DOT/1000PDP (95% CI, −3.8 to −1.2) by week initiated. Hospital length of stay, repeat antibiotics within 14 days, and 30-day readmission rate did not significantly change.

Conclusions

Forced function changes to existing eCDSTs, supported by stakeholder education, successfully changed IAI empiric antibiotic use without unintended patient safety consequences.
Improving Antibiotic Use for Ventilator-Associated Pneumonia Through Diagnostic Stewardship: A Proof-of-Concept Mixed Methods Study
Authors: Tripathi Ravi K , Kenaa Blaine , Claeys Kimberly C , Johnson J Kristie , Patel Meghana , Atkinson Jayne , Maldarelli Mary E , Newman Michelle , Leekha Surbhi
Published: September 2024

Background

Overtreatment of ventilator-associated pneumonia (VAP) in the intensive care unit is driven by positive respiratory tract cultures in the absence of a clinical picture of pneumonia. We evaluated the potential for diagnostic stewardship at the respiratory culture reporting step.

Methods

In this mixed methods study, we conducted a baseline evaluation of lower respiratory tract (LRT) culture appropriateness and antibiotic prescribing, followed by a nonrandomized intervention in 2 adult intensive care units. The intervention was a comment in the report to indicate potential colonization instead of organism identification when LRT cultures were inappropriate—that is, not meeting criteria for pneumonia as adjudicated by a physician using a standard algorithm.

Results

At baseline, among 66 inappropriate LRT cultures, antibiotic treatment for VAP was more frequent with identification of potential pathogens in the index culture when compared with no growth/normal flora (16/35 [46%] vs 7/31 [23%], P = .049). In the intervention period, 28 inappropriate cultures with growth of potential pathogens underwent report modification. The proportion of episodes for which antibiotic therapy for VAP was completed was significantly lower in the intervention group vs the baseline group (5/28 [18%] vs 16/35 [46%], P = .02).

Conclusions

Diagnostic stewardship for VAP could be facilitated by modification of LRT culture reporting guided by clinical features of pneumonia.
Deciphering the variability in air-sea gas transfer due to sea state and wind history
Authors: Yang Mingxi , Moffat David , Dong Yuanxu , Bidlot Jean-Raymond
Published: September 2024

Understanding processes driving air-sea gas transfer and being able to model both its mean and variability are critical for studies of climate and carbon cycle. The air-sea gas transfer velocity (K660) is almost universally parameterized as a function of wind speed in large scale models—an oversimplification that buries the mechanisms controlling K660 and neglects much natural variability. Sea state has long been speculated to affect gas transfer, but consistent relationships from in situ observations have been elusive. Here, applying a machine learning technique to an updated compilation of shipboard direct observations of the CO2 transfer velocity (KCO2,660), we show that the inclusion of significant wave height improves the model simulation of KCO2,660, while parameters such as wave age, wave steepness, and swell-wind directional difference have little influence on KCO2,660. Wind history is found to be important, as in high seas KCO2,660 during periods of falling winds exceed periods of rising winds by ∼20% in the mean. This hysteresis in KCO2,660 is consistent with the development of waves and increase in whitecap coverage as the seas mature. A similar hysteresis is absent from the transfer of a more soluble gas, confirming that the sea state dependence in KCO2,660 is primarily due to bubble-mediated gas transfer upon wave breaking. We propose a new parameterization of KCO2,660 as a function of wind stress and significant wave height, which resemble observed KCO2,660 both in the mean and on short timescales.
Preservation of independence and Goodman's riddle
Authors: Zinke Alexandra
Published: September 2024

The paper argues that relations of probabilistic independence between evidence statements must be preserved in enumerative induction. It further shows that, given such a preservation principle, there is a straightforward Bayesian solution to Goodman's new riddle of induction.
Study of the Neutrino–Oxygen Cross Sections of the Charged-Current Reaction 16O(ν̄e, e+)16N(0 MeV, 2–) and the Neutral-Current Reaction 16O(ν, ν′)16O(12.97/12.53 MeV, 2–), Producing High-Energy γ Rays
Authors: Sakuda Makoto , Suzuki Toshio , Nakazato Ken’ichiro , Suzuki Hideyuki
Published: September 2024

In our previous work, we discussed the cross section and the detection of 4.4 MeV $\gamma$ rays produced in the neutrino neutral-current (NC) reaction $^{16}$O$(\nu , \nu ^{\prime })^{16}$O(12.97 and 12.53 MeV, $2^-$) in a water Cherenkov detector at low energy below 100 MeV. In this report, we further investigate both the charged-current reaction $^{16}$O$(\bar{\nu }_e, e^+)^{16}$N(0 MeV, $2^-$) and the NC reaction$^{16}$O$(\nu , \nu ^{\prime })^{16}$O(12.97 and 12.53 MeV, $2^-$), producing high-energy $\gamma$ rays, in which a more solid identification of the reactions can be applied via the coincidence method.
Comprehensive detection and dissection of interlineage recombination events in the SARS-CoV-2 pandemic
Authors: Li Jia-Ying , Wang Hao-Yang , Cheng Ye-Xiao , Ji Chengyang , Weng Shenghui , Han Na , Yang Rong , Zhou Hang-Yu , Wu Aiping
Published: September 2024

The global prevalence of the XBB lineage presents a formidable challenge posed by the recombinant SARS-CoV-2 virus. The understanding of SARS-CoV-2’s recombination preference assumes utmost significance in predicting future recombinant variants and adequately preparing for subsequent pandemics. Thus, an urgent need arises to establish a comprehensive landscape concerning SARS-CoV-2 recombinants worldwide and elucidate their evolutionary mechanisms. However, the initial step, involving the detection of potential recombinants from a vast pool of over 10 million sequences, presents a significant obstacle. In this study, we present CovRecomb, a lightweight methodology specifically designed to effectively identify and dissect interlineage SARS-CoV-2 recombinants. Leveraging CovRecomb, we successfully detected 135,567 putative recombinants across the entirety of 14.5 million accessed SARS-CoV-2 genomes. These putative recombinants could be classified into 1451 distinct recombination events, of which 206 demonstrated transmission spanning multiple countries, continents, or globally. Hotspot regions were identified in six specific areas, with prominence observed in the latter halves of the N-terminal domain and receptor-binding domain within the spike (S) gene. Epidemiological investigations revealed extensive recombination events occurring among different SARS-CoV-2 (sub)lineages, independent of lineage prevalence frequencies.
Circ_0005397 inhibits ferroptosis of pancreatic cancer cells by up‐regulating PCBP2 through KAT6A/H3K9Ac
Authors: Qu Tengfei , Cha Lichao , Liu Hongliang , Tian Lantian , Hu Xiao , Zou Hao , Feng Yujie , Sun Chuandong , Cao Jingyu , Guo Weidong , Qiu Fabo , Zhou Bin
Published: September 2024

Pancreatic cancer is a highly aggressive and lethal carcinoma. Circular RNAs (circRNAs) serve key regulatory functions in pancreatic cancer. Ferroptosis was induced by erastin treatment and analyzed by examining malondialdehyde (MDA), iron, Fe2+ and glutathione (GSH). C11‐BODIPY 581/591 was used to stain cells for analyzing lipid peroxidation. RNA immunoprecipitation, pull‐down and chromatin immunoprecipitation assays were applied to evaluate intermolecular interaction. Mice received subcutaneous injection of pancreatic cancer cells as a model of subcutaneous tumor for in vivo tests. Circ_0005397 was abundantly expressed in pancreatic cancer, and its upregulation was associated with low survival of patients with pancreatic cancer. Circ_0005397 expression was induced by EIF4A3. PCBP2 was highly expressed in pancreatic cancer, and circ_0005397 and PCBP2 were positively correlated in patients with pancreatic cancer. Circ_0005397 knockdown sensitized pancreatic carcinoma cells to ferroptosis via downregulating PCBP2. Circ_0005397 promoted PCBP2 transcription via facilitating the binding of KAT6A and H3K9ac to PCBP2 promoter. Silencing of circ_0005397 reduced tumor growth by enhancing erastin‐induced ferroptosis in vivo. EIF4A3‐induced circ_0005397 inhibited erastin‐induced ferroptosis in pancreatic cancer by promoting PCBP2 expression through KAT6A and H3K9ac.
Factors Related to Firefighters' Food Behaviors at the Fire Station
Authors: Sire Thomas , Carbonneau Noémie , Houle Julie , Trudeau François , Gendron Philippe
Published: September 2024

Objective

Using a cross-sectional correlational study, the purpose was to quantitatively investigate factors associated to firefighters' food behaviors while on duty at the fire station.

Methods

Two hundred and fifty-two (252) firefighters (males, 96%; age, 39 ± 11 years) completed an online questionnaire assessing diet and exploring factors that could be associated to firefighters' food behaviors at the fire station.

Results

First regression analysis showed that level of education, years of experience, self-perceived nutrition knowledge, autonomous motivation, and accessibility to unhealthy foods were the best predictors of healthy food score. Second regression analysis revealed that body mass index, autonomous motivation, and meals interrupted by emergency calls were the best predictors of fast-food score.

Conclusions

This study highlights the various factors associated with firefighters' food behaviors at the fire station.
Determinants of Post-COVID Ill-Health in a Cohort of Canadian Healthcare Workers
Authors: Zadunayski Tanis , Durand-Moreau Quentin , Adisesh Anil , Burstyn Igor , Labrèche France , Ruzycki Shannon , Cherry Nicola
Published: September 2024

Objective

We aimed to estimate prevalence of post-COVID conditions (PCCs) among healthcare workers (HCWs) and to identify predisposing factors.

Methods

A cohort of Canadian HCWs completed four questionnaires during the pandemic. At the final questionnaire, HCWs reported conditions attributed to earlier COVID-19. The proportion developing a PCC was estimated. Risk factors were evaluated by logistic regression.

Results

Among 4964 HCWs, 995 had one positive COVID test >90 days before completing the final questionnaire. A total of 266 (27%) developed a PCC. Factors predisposing HCWs to a PCC included depression and increased alcohol consumption reported preinfection, chronic ill-health prepandemic, and a perception that the infection was work-related. PCCs were less likely following vaccination. Most HCWs (98%) returned to work within 30 days, with 8% reporting severe PCC (n = 80).

Conclusions

Predisposing factors reflected poor health preinfection. Most conditions were mild.
Role of microenvironment characteristics and MRI radiomics in the risk stratification of distant metastases in rectal cancer: a diagnostic study
Authors: Zhao Qing , Zhong Hongxia , Guan Xu , Wan Lijuan , Zhao Xinming , Zou Shuangmei , Zhang Hongmei
Published: September 2024

Objectives:

To compare the value of tumor stroma ratio (TSR) and radiomic signature from baseline MRI for stratifying the risk of distant metastases (DM) in patients with locally advanced rectal cancer (LARC).

Materials and methods:

Data from 302 patients with LARC who underwent neoadjuvant chemoradiotherapy and total mesorectal excision in our hospital between 2015 and 2018 were retrospectively reviewed, and the patients were randomly allocated into the training and validation cohorts in a ratio of 7:3. Patients were followed-up for more than 3 years postoperatively with metachronous DM as the endpoint. Independent risk factors for DM-free survival (DMFS) were analyzed using Cox regression. The TSR of endoscopic biopsy specimens was scored automatically. Totally 1229 radiomic features of each tumor were extracted from baseline MRI, and the Radscore was calculated.

Results:

The median follow-up time was 54.3 (51.6–57.1) months, and the 3-year DMFS was 83.8%. The best cutoff value of the TSR to distinguish a patient’s DM risk was 0.477 (Sen=70.8%, Sep=78%, P<0.001). Increased TSR (HR=3.072, P=0.006) and Radscore (HR=719.231, P=0.023), advanced MR-evaluated T stage (HR=2.660, P=0.023) and ypN (HR=2.362, P=0.028) stage were independent risk factors for DMFS. The area under the curve of the combined model was significantly higher than that of the radiomic model (P=0.013) but without a significant advantage over the TSR model (P=0.086).

Conclusion:

TSR of colonoscopic biopsies can independently stratify DM risk in patients with LARC. The TSR model is the most convenient and efficient method for DM risk stratification in LARC.
Cumulative risk factors for flap failure, thrombosis, and hematoma in free flap reconstruction for head and neck cancer: a retrospective nested case-control study
Authors: Hsiung Pei-Hsin , Huang Ho-Yin , Chen Wei-Yu , Kuo Yur-Ren , Lin Ying-Chi
Published: September 2024

Background:

Free flap construction enhances the quality of life for head and neck cancer (HNC) patients; however, complications, such as thrombosis and hematoma, threaten flap survival. This study aimed to identify factors influencing flap failure, thrombosis, and hematoma.

Methods:

A retrospective nested case-control study was conducted on HNC patients who underwent free flap reconstruction at a tertiary medical center between January 2019 and January 2022. All patients received antithrombotic prophylaxis consisting of prostaglandin E1, dextran, aspirin, and dipyridamole. Risk factors were analyzed using multivariate logistic regression.

Results:

Among 548 flaps analyzed, flap failure, thrombosis, and hematoma rates were 4.74%, 3.83%, and 9.65%, respectively. Risk factors for flap failure included thrombosis (OR 86.42, 95% CI 15.73–474.89), smoking (OR 49.44, 95% CI 1.28–>1000), posteromedial thigh (PMT) flap usage (OR 14.05, 95% CI 2.48–79.54), hematoma (OR 9.68, 95% CI 2.35–39.79), and younger age (OR 0.93, 95% CI 0.87–0.99). Thrombosis risk factors included PMT usage (OR 11.45, 95% CI 2.60–50.38) and anastomosis with the superior thyroid vein (SThV) as the recipient vein after multiple reconstructions (OR 7.91, 95% CI 2.06–30.39). Hematoma risk factors included fibula osteocutaneous flap usage (OR 9.22, 95% CI 2.71–31.42), double-flap usage (OR 8.88, 95% CI 1.80–43.81), liver cirrhosis (OR 6.28, 95% CI 1.44–27.47), and post-surgery hypertension (OR 2.77, 95% CI 1.39–5.50), whereas ipsilateral recurrence (OR 0.14, 95% CI 0.03–0.73) and using the external jugular vein (EJV) as the recipient vein (OR 0.22, 95% CI 0.08–0.61) were protective factors.

Conclusion:

Thrombosis poses a greater risk than hematoma for flap failure. Utilization of the PMT flap and the SThV markedly increased the risk of thrombosis and flap failure. These findings highlight the importance of antithrombotic prophylaxis and the selection of flaps and recipient veins in recurrent HNC patients.
Innovative hydrogel solutions for articular cartilage regeneration: a comprehensive review
Authors: Kang Yue , Guan Yujing , Li Shenglong
Published: September 2024

Articular cartilage damage is predominantly caused by trauma, osteoarthritis (OA), and other pathological conditions. The limited intrinsic capacity of cartilage tissue to self-repair necessitates timely intervention following acute injuries to prevent accelerated degeneration, leading to the development of planar arthritis or even osteoarthritis. Unfortunately, current therapies for articular cartilage damage are inadequate in effectively replacing or regenerating compromised cartilage due to the absence of suitable tissue-engineered artificial matrices. However, there is promise in utilizing hydrogels, a category of biomaterials characterized by their elasticity, smooth surfaces, and high water content, for cartilage regeneration. Recent advancements in hydrogel engineering have focused on improving their bioactive and physicochemical properties, encompassing innovative composition designs, dynamic modulation, and intricate architectures. This review provides a comprehensive analysis of hydrogels for articular cartilage repair, focusing on their innovative design, clinical applications, and future research directions. By integrating insights from the latest research studies and clinical trials, the review offers a unique perspective on the translation of hydrogels for articular cartilage repair, underscoring their potential as promising therapeutic agents.
Current advancements in nanotechnology for stem cells
Authors: Thamarai Packiyam , Karishma Suresh , Kamalesh Raja , Shaji Alan , Saravanan Anbalagan , Bibi Shabana , Vickram Agaram Sundaram , Chopra Hitesh , Saleem Rimah A. , Alsharif Khalaf F. , Theyab Abdulrahman , Kamel Mohamed , Alamoudi Mariam K. , Kumer Ajoy , Chopra Shivani , Abdel-Daim Mohamed M.
Published: September 2024

Stem cell therapy has emerged as a promising approach for regenerative medicine, offering potential treatments for a wide range of diseases and injuries. Although stem cell therapy has great promise, several obstacles have prevented its broad clinical adoption. The effectiveness of therapy has been inhibited by problems such as ineffective stem cell differentiation, low post-transplantation survival rates, and restricted control over stem cell behavior. Furthermore, the implementation of stem cell therapies is further complicated by the possibility of immunological rejection and cancer. Innovative strategies that provide precise control over stem cell characteristics and maximize their therapeutic potential are desperately needed to overcome these obstacles. Recent studies have shown that the effectiveness of stem cell treatments can be greatly increased by nanoscale advances. By establishing an ideal microenvironment and precisely offering growth factors, nanomaterials such as nanoparticles, nanocomposites, and quantum dots have been demonstrated to improve stem cell differentiation and proliferation. This article provides an overview of the recent trends and applications of nanoscale innovations in the context of stem cell therapy. The recent development of precision medicine has been facilitated by the incorporation of nanotechnology into stem cell therapy. The ability to manipulate stem cells at the nanoscale offers unprecedented control over their behavior and function, opening up exciting possibilities for personalized and highly effective therapeutic interventions. This review paper highlights the recent trends and applications of nanotechnology in advancing stem cell therapy, showcasing its potential to revolutionize regenerative medicine.
Sexual Violence, Genital Cytokines, and Colposcopy Findings: A Cross-Sectional Study of Women Engaged in Sex Work in Mombasa, Kenya
Authors: Kwendakwema C. Natasha , Sabo Michelle C. , Roberts Sarah T. , Masese Linnet , McClelland R. Scott , Shafi Juma , Lehman Dara A. , Overbaugh Julie , Graham Susan M.
Published: September 2024

Background

Sexual violence (SV) increases human immunodeficiency virus (HIV) susceptibility in a sustained manner. This study evaluated genital cytokines and colposcopy findings in women reporting both recent and more remote SV.

Methods

A cross-sectional study of HIV-1 negative Kenyan women who engage in sex work was performed. Cervicovaginal fluid was collected by menstrual cup and cytokines (IFNγ, TNFα, IL-1β, IL-6, IL-10, MIP-1α, MIP-1β, and CXCL10) measured using chemiluminescence. Cervical injury was assessed by colposcopy. Associations between recent (≤30 days prior), more remote (>30 days prior), and no (reference category) SV exposure and cytokine concentrations were evaluated using linear regression.

Results

Among 282 participants, 25 (8.9%) reported recent SV and 123 (43.6%) reported more remote SV. Only two cytokines (IL-10 and CXCL10) were associated with the 3-category SV variable in bivariable modeling at the prespecified cutoff (P < 0.2) and carried forward. In multivariable analyses, more remote SV (β = 0.72; 95% confidence interval [CI], 0.06–1.38; P = 0.03), but not recent SV (β = 0.20; 95% CI, −0.99 to 1.39; P = 0.74) was associated with cervicovaginal IL-10 compared with no SV. Recent (β = 0.36; 95% CI, −0.94 to 1.67; P = 0.58) and more remote (β = 0.51; 95% CI, −0.21 to 1.24; P = 0.16) SV were not associated with CXCL10 compared with no SV. Cervical epithelial friability (χ2 = 1.3, P = 0.51), erythema (χ2 = 2.9, P = 0.24), vascular disruption (χ2 = 1.4; P = 0.50), epithelial disruption (χ2 = 2.6, P = 0.27), or any colposcopy finding (χ2 = 1.2, P = 0.54) were not associated with SV category by χ2 test.

Conclusions

The mechanism linking SV to sustained increases in HIV susceptibility may not be related to persistent genital inflammation or injury.
Prehabilitation Research: A Bibliometric Analysis of Past Trends and Future Directions
Authors: Yoo Myungeun , Jang Chan Woong
Published: September 2024

Objective

This study investigates the global research landscape of prehabilitation, identifying current trends, dominant disciplines, collaborative networks, and prominent articles in the field.

Design

For our analysis, we employed the published prehabilitation literature indexed in the Web of Science Core Collection database, spanning from 2002 to 2022. Additionally, we utilized CiteSpace (version 6.2; Drexel University), a widely used information visualization software to perform bibliometric analysis.

Results

Analyzing 553 research articles, we observe a consistent upward trend in prehabilitation publication and citation activity. Interdisciplinary co-occurrence analysis highlights strong connections with fields such as surgery, rehabilitation, oncology, sports sciences, orthopedics, gastroenterology, and hepatology. Initially centered around postoperative outcomes in major abdominal surgeries, particularly for colorectal, pancreatic, and prostate cancers, prehabilitation research expanded to include thoracic surgeries, focusing on conditions like lung cancer and aortic valve replacement. Preoperative exercise remains a core area, with increasing interest in multimodal prehabilitation and its effectiveness based on patient group characteristics. North America and Western Europe emerge as primary contributors to prehabilitation research.

Conclusion

Current research concentrates on tailoring prehabilitation programs for specific groups, and broadening their geographical scope would enhance the studies, contributing valuable insights for medical practitioners shaping future research efforts.
The Incidence and Nature of Adverse Events During Inpatient Rehabilitation: A Retrospective Case Series
Authors: Jiang Shangge , Othman Dalia , Langer Laura Kathleen , Bayley Mark , Fortin Christian , Mayo Amanda , Pelc Jordan , Robinson Lawrence R. , Soong Christine , Guo Meiqi
Published: September 2024

Objective

To describe and compare adverse event (AE) incidence, type, severity, and preventability in the Canadian inpatient rehabilitation setting.

Design

In this retrospective case series, AEs were identified through chart reviews from two Canadian academic tertiary post-acute care hospitals. AEs were characterized through descriptive statistics and compared using the Mantel-Haenszel and Fisher’s exact tests.

Results

During the study period, one site (n = 120) had 28 AEs and an incidence of 9.7 (95% CI 6.1–13.3) per 1000 patient days, and the other (n = 48) had 15 AEs and an incidence of 13.9 (95% CI 6.9–21) per 1000 patient days (p = 0.82). The two sites differed significantly in AE type (p = 0.033) and preventability (p = 0.002) but not severity. The most common AE type was medication/intravenous fluids-related (16/28, 57%) at one site and patient incidents (e.g., falls, pressure ulcers) at the other. Four percent (1/28) of AEs were preventable at one site, and 53% (8/15) at another. Most AEs at both sites were mild in severity.

Conclusions

AEs significantly differed in type and preventability between the two sites. These results suggest the importance of context and the need for an organization-specific and tailored approach when addressing patient safety in inpatient rehabilitation settings.
68Ga-FAPI PET/CT Depicted the Fibrosis of Ischemic Colitis
Authors: Zheng Jieling , Ru Qian , Yang Yun , Miao Weibing
Published: September 2024

Ischemic colitis is the most common form of ischemic bowel disease; identification of ischemic colitis with PET/CT is rare. We present a case of unexplained ischemic colitis in a 66-year-old man who underwent 18F-FDG PET/CT to exclude intestinal malignancy and was subsequently recruited in a clinical trial regarding 68Ga-FAPI. 18F-FDG PET/CT showed intense activity in the intestinal lumen where mucosa had chronic inflammation. Conversely, 68Ga-FAPI PET/CT revealed high tracer uptake in the intestinal wall and adjacent mesentery. Our case showed the different distribution pattern of 18F-FDG and 68Ga-FAPI in ischemic colitis.
Peritoneal Metastasis of Osteosarcoma in 99mTc-MDP SPECT/CT Imaging
Authors: Shen Chentian
Published: September 2024

An 11-year-old boy with history of conventional high-grade osteosarcoma in the left distal femur was referred to our department for 99mTc-MDP whole-body bone scan. In addition to multiple bone lesions and pleura, abnormal high radioactivity was found in the abdomen. SPECT/CT revealed diffuse peritoneal thickening with calcification and increased radioactive uptake, which suggest peritoneal metastases. The most common metastases of osteosarcoma can be found in bone and lungs, whereas peritoneal metastases are extremely rare.
Early Experience of Peer Advocate Program: Using Quality Improvement to Optimize Behavioral and Communication Disconnect in the Operating Room
Authors: Eckhouse Shaina R , Huston Margaret , Smith Eileen R , Thomson Emily , Theodorou Danielle , Chilson Kelly , Osborn Tiffany M , Ogden M Allison , Hoffman Russell , Martin Jackie L
Published: September 2024

BACKGROUND:

The operating room (OR) remains a challenging and hierarchical work environment within healthcare, where the attending surgeon functions as a team captain. Unprofessional behavior or disconnects in this environment can lead to breakdowns in teamwork and reports within the safety event reporting system (SERS). Interventions focused on remediating adverse behaviors and team interactions should optimize team function and potentially enhance patient outcomes. The aim of the present study focused on decreasing the SERS reports regarding behavior and communication disconnects from November 2019 to March 2023.

STUDY DESIGN:

A multidisciplinary team designed a novel reporting system to separate mechanical and procedural safety events from communication and behavior-related disconnects in the OR. The following plan-do-study-act cycles were performed by the multidisciplinary team: (1) developed the role of the peer advocate (PA) to mediate conversations among team members when behavior and communication disconnects occur, (2) redirect behavior and communication disconnects reported in the SERS to the PA program, and (3) develop and discuss interpersonal skills to prevent disconnects from occurring.

RESULTS:

Thirty-nine disconnects were reported through the PA program during the 2-year trial. The most common initiating team member were nurses, and the most common identifying team member were surgeons. The number of monthly SERS reports regarding behavior and communication disconnects decreased with the described interventions.

CONCLUSIONS:

The multidisciplinary task force developed and adapted a process to address communication and behavioral concerns in an efficient and supportive manner, with the objective of restoring relationships among team members in the perioperative environment and deweaponizing the SERS.
Retrospective analysis of Acinetobacter baumannii bacteraemia risk factors, complications, and mortality in a tertiary university hospital in Saudi Arabia
Authors: Kaki Reham
Published: September 2024

Introduction.
There are many multidrug-resistant isolates of the nosocomial pathogen, Acinetobacter baumannii causing severe healthcare-acquired infections in terminally ill patients with high mortality and morbidity rates.
 
Aim. This study aimed to retrospectively analyse Acinetobacter baumannii bacteraemia (ABB) cases in Saudi Arabia where the information is sparse regarding the prevalence, risk factors, clinical disease, antibiotic regimen, antibiotic susceptibility, treatment outcomes, and mortality associated with this infection.
 
Methods.  A retrospective chart review was conducted between January 1st, 2015, and December 31st, 2022, to identify all patients 14 years and above with ABB. Demographic and clinical data, as well as results from laboratory analyses, were collected from patients’ electronic charts. Statistical analyses were performed on the data to identify factors associated with 90-day mortality.
 
Results. Of the 122 ABB cases, 71 (63.4%) died. The factors that were found to be associated with 90-day mortality were the Charlson comorbidity score, Pitt bacteremia score, quick Sequential Organ Failure Assessment (qSOFA) score (p < 0.001 for each), hospital ward (p < 0.02), short duration of antibiotic treatment (p < 0.01), and higher age (p < 0.05). The most common source of infection was Central Line-associated Bloodstream Infection in 52.7%. Also associated with mortality were inappropriate antimicrobial therapy (p < 0.02) and empirical use of colistin (p < 0.05). In many patients, ABB was caused by carbapenem-resistant A. baumannii (CRAB) (69.6%), and 74.4% of those patients died.
 
Conclusion. To prevent ABB-associated mortality, an appropriate regimen and duration of treatment are necessary. Hospitals should also practice proper hygiene to prevent the spread of ABB. CRAB is a growing threat in hospitals in Saudi Arabia especially in the critical care setting and carries a very high risk of mortality.
Clinical presentation and microbiological characteristics of community-acquired Staphylococcus aureus bacteraemia at a tertiary hospital in Costa Rica
Authors: Solís Natalia , Pérez Cristian , Ramírez Manuel , Castro José , Rodríguez César
Published: September 2024

Introduction.
Staphylococcus aureus is a leading agent in community-acquired bacteraemia (CAB) and has been linked to elevated mortality rates and methicillin resistance in Costa Rica.

Gap statement and aim. To update and enhance previous data obtained in this country, we analysed the clinical manifestations of 54 S. aureus CAB cases in a tertiary hospital and delineated the sequence types (STs), virulome, and resistome of the implicated isolates.

Methodology. Clinical information was retrieved from patient files. Antibiotic susceptibility profiles were obtained with disc diffusion and automated phenotypic tests. Genomic data were exploited to type the isolates and for detection of resistance and virulence genes.

Results. Primary infections predominantly manifested as bone and joint infections, followed by skin and soft tissue infections. Alarmingly, 70% of patients continued to exhibit positive haemocultures beyond 48 h of treatment modification, with nearly a quarter requiring mechanical ventilation or developing septic shock. The 30-day mortality rate reached an alarming 40%. More than 60% of the patients were found to have received suboptimal or inappropriate antibiotic treatment, and there was an alarming tendency towards the overuse of third-generation cephalosporins as empirical treatment. Laboratory tests indicated elevated creatinine levels, leukocytosis, and bandaemia within the first 24 h of hospitalization. However, most showed improvement after 48 h. The isolates were categorized into 13 STs, with a predominance of representatives from the clonal complexes CC72 (ST72), CC8 (ST8), CC5 (ST5, ST6), and CC1 (ST188). Twenty-four isolates tested positive for mecA, with ST72 strains accounting for 20. In addition, we detected genes conferring acquired resistance to aminoglycosides, MLSB antibiotics, trimethoprim/sulfamethoxazole, and mutations for fluoroquinolone resistance in the isolate collection. Genes associated with biofilm formation, capsule synthesis, and exotoxin production were prevalent, in contrast to the infrequent detection of enterotoxins or exfoliative toxin genes.

Conclusions. Our findings broaden our understanding of S. aureus infections in a largely understudied region and can enhance patient management and treatment strategies.