bluuebunny/crossref_metadata_2025 huggingface dataset:
Process Optimization for Supercritical Carbon Dioxide Extraction of Origanum vulgare L. Essential Oil Based on the Yield, Carvacrol, and Thymol Contents
Authors: Lin Guodong , Cheng Feng , Aimila Aoken , Zhang Junping , Maiwulanjiang Maitinuer
Published: May 2022

Background

Origanum vulgare L. essential oil (OEO) is widely known for its good biological activity, but different extraction methods with significant implications on the yield of OEO and the content of the thymol and carvacrol. As an efficient method for extracting essential oils (EO), the supercritical carbon dioxide extraction (SC-CO2) can improve the yield of EOs while protecting their main active components from loss.

Objective

In this study, the process optimization of SC-CO2 of OEO was carried out. The effects of extraction pressure, temperature, time, and modifier concentration on the composite score of OEO extraction process were investigated.

Method

Response surface analysis was performed using a Box-Behnken design with three levels and four independent variables. Steam distillation (SD) and lipophilic solvents (n-hexane) extraction (LSE) were compared with SC-CO2 for OEO yields. OEOs extracted by the three methods were qualitatively and semi-quantitatively analyzed by gas chromatography quadrupole-time-of-flight mass spectrometry and gas chromatography-flame ionization detector.

Results

The results showed that extraction pressure was the most significant factor affecting the OEO yield, thymol, and carvacrol content. In the optimal conditions (pressure: 217 bar, temperature: 54°C, time: 2 h, modifier concentration: 14%), the yield of OEO reached up to 1.136%, and the contents of thymol and carvacrol reached 53.172  and 41.785 mg/g, respectively.

Conclusions

SC-CO2 was the best extraction method compared to the other two methods. Under the optimal conditions, yield and the content of main components can be effectively improved. It can provide a theoretical basis for the industrial extraction of OEO.

Highlights

Taking the comprehensive score as the index, the interaction between the four independent variables in the supercritical fluid extraction process was evaluated by the response surface method. The effects of extraction parameters on the yield of EOs and the contents of thymol and carvacrol were comprehensively investigated.
Self-Regulation as a Protective Factor for Diabetes Distress and Adherence in Youth with Type 1 Diabetes During the COVID-19 Pandemic
Authors: Miller Alison L , Albright Dana , Bauer Katherine W , Riley Hurley O , Hilliard Marisa E , Sturza Julie , Kaciroti Niko , Lo Sharon L , Clark Katy M , Lee Joyce M , Fredericks Emily M
Published: May 2022

Objective

The COVID-19 pandemic increased economic, social, and health stressors for families, yet its impacts on families of youth with chronic conditions, such as type 1 diabetes (T1D), are not well understood. Self-regulation (SR)—or the capacities to control emotions, cognition, and behavior in response to challenge—is known to support T1D management and coping in the face of stress. Strong SR may have protected youth with T1D from the impacts of pandemic-related stressors. This study compared youth and parent emotional functioning and T1D management before and after the pandemic’s onset in relation to family pandemic-related stress and youth SR.

Methods

Parents of youth with T1D (N = 88) and a subset of these youth (N = 43; Mean age 15.3 years [SD 2.2]) completed surveys regarding SR, stress, emotional functioning, and T1D-related functioning prior to and after March 2020. Outcomes were compared using mixed effects models adjusting for covariates. Family pandemic-related stress experiences and youth SR were tested as moderators of change.

Results

Parents’ responsibility for T1D management increased across pandemic onset and their diabetes-related distress decreased. Family pandemic-related stress was associated with decreased emotional functioning over time. Youth SR, particularly emotional and behavioral aspects, predicted better emotional and T1D-related functioning.

Discussion

While youth with T1D whose families experienced higher pandemic-related stress had poorer adjustment, strong emotional and behavioral SR appeared to protect against worsening youth mood and adherence across pandemic onset. Both social-contextual and individual factors are important to consider when working with families managing T1D.
Combining datasets for maize root seedling traits increases the power of GWAS and genomic prediction accuracies
Authors: Zuffo Leandro Tonello , DeLima Rodrigo Oliveira , Lübberstedt Thomas
Published: May 2022

The identification of genomic regions associated with root traits and the genomic prediction of untested genotypes can increase the rate of genetic gain in maize breeding programs targeting roots traits. Here, we combined two maize association panels with different genetic backgrounds to identify single nucleotide polymorphisms (SNPs) associated with root traits, and used a genome-wide association study (GWAS) and to assess the potential of genomic prediction for these traits in maize. For this, we evaluated 377 lines from the Ames panel and 302 from the Backcrossed Germplasm Enhancement of Maize (BGEM) panel in a combined panel of 679 lines. The lines were genotyped with 232 460 SNPs, and four root traits were collected from 14-day-old seedlings. We identified 30 SNPs significantly associated with root traits in the combined panel, whereas only two and six SNPs were detected in the Ames and BGEM panels, respectively. Those 38 SNPs were in linkage disequilibrium with 35 candidate genes. In addition, we found higher prediction accuracy in the combined panel than in the Ames or BGEM panel. We conclude that combining association panels appears to be a useful strategy to identify candidate genes associated with root traits in maize and improve the efficiency of genomic prediction.
Medical Students’ Professional Identity Formation During Operation Bushmaster
Authors: Cole Rebekah , Peters Sidney A , Garrigan Audra G , Tilley Laura , Conley Sean P , Schwartz James , Vojta Leslie , Rudinsky Sherri L
Published: May 2022

Introduction

The role of the military medical officer is complex, as it encapsulates officer, physician, and leader. Professional identity formation is therefore essential for military medical students and junior military physicians to successfully execute the responsibilities of the military medical officer in their future careers. Because little is known regarding best practices for professional identity formation training for military physicians, this study explored the ways in which medical students conceptualized the complex roles of the military medical officer during a medical field practicum.

Materials and Methods

Guided by the phenomenological tradition of qualitative research, we interviewed 15 fourth-year medical students twice regarding their understanding of the role of the military medical officer, as they progressed through a 5-day high-fidelity military medical field practicum, Operation Bushmaster. Our research team then analyzed the interview transcripts for emerging themes and patterns, which served as the results of this study.

Results

The following themes emerged from the data regarding the participants’ conceptualization of the military medical officer: (1) the scope of the role of the military medical officer; (2) the intersecting identities of the military medical officer; and (3) the adaptable role of the military medical officer in an operational environment. As they progressed through the medical field practicum, the participants articulated a clear understanding of the vast and complex nature of the military medical officer’s intersecting roles as officer, physician, and leader in austere and often unpredictable environments. At the end of the medical field practicum, the participants expressed confidence in carrying out their roles as military medical officers during their future deployments.

Conclusions

This study provided an in-depth understanding of the participants’ conceptualization of the military medical officer. The participants described how the medical field practicum provided them with opportunities to experience first-hand and therefore better understand the roles of the military medical officer while leading a health care team in an operational environment. As a result, high-fidelity medical field practicums like Operation Bushmaster appear to be an effective tool for facilitating professional identity formation.
Non-metabolic functions of phosphofructokinase-1 orchestrate tumor cellular invasion and genome maintenance under bevacizumab therapy
Authors: Lim Yi Chieh , Jensen Kamilla E , Aguilar-Morante Diana , Vardouli Lina , Vitting-Seerup Kristoffer , Gimple Ryan C , Wu Qiulian , Pedersen Henriette , Elbaek Kirstine J , Gromova Irina , Ihnatko Robert , Kristensen Bjarne W , Petersen Jeanette K , Skjoth-Rasmussen Jane , Flavahan William , Rich Jeremy N , Hamerlik Petra
Published: May 2022

Background

Glioblastoma (GBM) is a highly lethal malignancy for which neoangiogenesis serves as a defining hallmark. The anti-VEGF antibody, bevacizumab, has been approved for the treatment of recurrent GBM, but resistance is universal.

Methods

We analyzed expression data of GBM patients treated with bevacizumab to discover potential resistance mechanisms. Patient-derived xenografts (PDXs) and cultures were interrogated for effects of phosphofructokinase-1, muscle isoform (PFKM) loss on tumor cell motility, migration, and invasion through genetic and pharmacologic targeting.

Results

We identified PFKM as a driver of bevacizumab resistance. PFKM functions dichotomize based on subcellular location: cytosolic PFKM interacted with KIF11, a tubular motor protein, to promote tumor invasion, whereas nuclear PFKM safeguarded genomic stability of tumor cells through interaction with NBS1. Leveraging differential transcriptional profiling, bupivacaine phenocopied genetic targeting of PFKM, and enhanced efficacy of bevacizumab in preclinical GBM models in vivo.

Conclusion

PFKM drives novel molecular pathways in GBM, offering a translational path to a novel therapeutic paradigm.
Isolated severe rhabdomyolisis revealing COVID-19: case report
Authors: Merbouh M , El Aidouni G , Serbource J , Couprie L M , Bernardoni C , Housni B , Monchi M
Published: May 2022

Covid-19 remains a multisystem viral-related disease surprising the healthcare teams. We report the case of a patient presenting with rhabdomyolysis in the context of COVID-19 disease.
A case of recurrent pneumothorax and skin lesions diagnosed with Birt–Hogg–Dubé
Authors: Takaldani Ali Hossein Samadi , Negaresh Mohammad , Jalalzadeh Solmaz , Lotfi Leila , Ghobadi Hassan
Published: May 2022

Birt–Hogg–Dubé (BHD) syndrome is an autosomal dominant disease that is manifested as benign cutaneous tumors, multiple lung parenchymal cysts and an increased risk of renal cancer. Its symptoms usually do not appear until adulthood. We report a patient who was admitted with recurrent pneumothorax. Discovering typical cutaneous lesions accompanied with a history of the same condition in his son, BHD syndrome was diagnosed.
Clinical and Laboratory Findings of SARS-CoV-2 Infection in Children Younger than 6 Months Old: Neutropenia is More Common Not Lymphopenia
Authors: Guner Ozenen Gizem , Sahbudak Bal Zumrut , Bilen Nimet Melis , Yildirim Arslan Sema , Ak Gunes , Koc Gonca , Cicek Candan , Kurugol Zafer , Ozkinay Ferda
Published: May 2022

Background

Studies on age-related differences in clinical and laboratory features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are limited. We aimed to evaluate the demographic, clinical, laboratory findings of SARS-CoV-2 infection in children younger than 6 months old and compare them with older children.

Methods

A single-center retrospective study, including 209 confirmed SARS-CoV-2 infection cases, was conducted between 11 March 2020 and 1 September 2021. The case group consisted of 47 patients younger than 6 months old, whereas the control group consisted of 162 patients older than 6 months old.

Results

The mean age of the case group was 2.77 ± 1.52 months, and the control group was 101.89 ± 65.77 months. Cough was statistically higher in the control group, and poor feeding was higher in the case group (p = 0.043, 0.010). The underlying disease rate was statistically higher in the control group; however, the hospitalization rate was higher in the case group (p = 0.036, 0.001). The case group had significantly lower median values of the absolute neutrophil count, hemoglobin and higher median values of white blood cell, absolute lymphocyte count and platelet than the control group (p < 0.05). C-reactive protein, fibrinogen values were significantly lower, and procalcitonin, D-dimer, troponin T, N-terminal pro-B-type natriuretic peptide significantly higher in the case group (p < 0.05). Lymphopenia was more common in the control group, whereas neutropenia was more common in the case group (p = 0.001, 0.011).

Conclusions

We showed that most children younger than 6 months old had mild and asymptomatic SARS-CoV-2 infection; however, the hospitalization rate was higher, and neutropenia was more common in older children.

Lay summary

Studies on age-related differences in clinical and laboratory features on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pediatric patients are limited. We aimed to evaluate the demographic, clinical and laboratory findings of SARS-CoV-2 infection in children younger than 6 months old and compare them with older children. A single-center retrospective study was conducted, including 209 SARS-CoV-2 infection cases. The case group consisted of 47 patients younger than 6 months old, and the control group consisted of 162 patients older than 6 months old. Most children younger than 6 months old had mild and asymptomatic SARS-CoV-2 infection; however, the hospitalization rate was higher than older children. Neutropenia was more common in patients younger than 6 months than older children with SARS-CoV-2 infection, even if underlying diseases were excluded.
Ultraviolet-C radiation
Authors: Smith Mairead
Published: May 2022

In response to the COVID-19 pandemic, healthcare facilities have purchased more ultraviolet-C (UVC) disinfection devices than in previous years. This article discusses the safety and efficacy of UVC disinfection in healthcare settings.
Weight stigma in children and adolescents
Authors: Roberts Karyn J. , Polfuss Michele L.
Published: May 2022

Weight stigma is the devaluation of a person because of excess body weight. Individuals who experience stigmatization are at increased risk for adverse physical and psychological health outcomes. This article provides an overview of weight stigma and the implications for nursing practice and policy.
The COVID-19 experience
Authors: Malaska Mary , Cluck Alana , Porter Mckinzey , Mahaffey Carlos , Han Ho , Clement Deja
Published: May 2022

Purpose:

To explore the psychological factors that impacted RNs during the COVID-19 pandemic.

Methods:

Survey response data were collected from 151 respondents across 25 states and various healthcare system settings.

Results:

RNs in clinical settings had slightly more emotional stress than those in academia. Concerns ranged from personal health and family considerations to large-scale sociopolitical issues.

Conclusions:

RNs in all settings experienced at least some emotional stress during the early stages of the pandemic. However, in a majority of respondents, none of the stressors individually or in combination were so great as to encourage departure from the profession.
Open Ankle Reconstruction of Lateral Ligaments (O-Anti-RoLL)
Authors: Glazebrook Mark , Stone James W. , Pasache Lozano Rocio del Pilar , Morash Joel , Takao Masato
Published: May 2022

Ankle instability is a disabling condition that severely affects people’s quality of life. Nonoperative options have been suggested however a surgical procedure is often required to improve symptomatology and function of the ankle joint. In the current paper we describe a surgical technique of an open ankle reconstruction of the lateral ligaments (O-Anti-RoLL), which is a simple and safe surgical technique that utilizes an anatomic Y-graft.

Level of Evidence: Diagnostic Level V. Expert opinion. See Instructions for Authors for a complete description of levels of evidence.
Probiotics in Critical Illness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Sharif Sameer , Greer Alisha , Skorupski Clarissa , Hao Qiukui , Johnstone Jennie , Dionne Joanna C. , Lau Vincent , Manzanares William , Eltorki Mohamed , Duan Erick , Lauzier Francois , Marshall John C. , Heels-Ansdell Diane , Thabane Lehana , Cook Deborah J. , Rochwerg Bram
Published: May 2022

OBJECTIVES:

To determine the safety and efficacy of probiotics or synbiotics on morbidity and mortality in critically ill adults and children.

DATA SOURCES:

We searched MEDLINE, EMBASE, CENTRAL, and unpublished sources from inception to May 4, 2021.

STUDY SELECTION:

We performed a systematic search for randomized controlled trials (RCTs) that compared enteral probiotics or synbiotics to placebo or no treatment in critically ill patients. We screened studies independently and in duplicate.

DATA EXTRACTION:

Independent reviewers extracted data in duplicate. A random-effects model was used to pool data. We assessed the overall certainty of evidence for each outcome using the Grading Recommendations Assessment, Development, and Evaluation approach.

DATA SYNTHESIS:

Sixty-five RCTs enrolled 8,483 patients. Probiotics may reduce ventilator-associated pneumonia (VAP) (relative risk [RR], 0.72; 95% CI, 0.59 to 0.89 and risk difference [RD], 6.9% reduction; 95% CI, 2.7–10.2% fewer; low certainty), healthcare-associated pneumonia (HAP) (RR, 0.70; 95% CI, 0.55–0.89; RD, 5.5% reduction; 95% CI, 8.2–2.0% fewer; low certainty), ICU length of stay (LOS) (mean difference [MD], 1.38 days fewer; 95% CI, 0.57–2.19 d fewer; low certainty), hospital LOS (MD, 2.21 d fewer; 95% CI, 1.18–3.24 d fewer; low certainty), and duration of invasive mechanical ventilation (MD, 2.53 d fewer; 95% CI, 1.31–3.74 d fewer; low certainty). Probiotics probably have no effect on mortality (RR, 0.95; 95% CI, 0.87–1.04 and RD, 1.1% reduction; 95% CI, 2.8% reduction to 0.8% increase; moderate certainty). Post hoc sensitivity analyses without high risk of bias studies negated the effect of probiotics on VAP, HAP, and hospital LOS.

CONCLUSIONS:

Low certainty RCT evidence suggests that probiotics or synbiotics during critical illness may reduce VAP, HAP, ICU and hospital LOS but probably have no effect on mortality.
Psychometric Evaluation of the Capstone Core Competency Scale on Nursing Students in Taiwan
Authors: TSENG Hui-Chen , KO Hsun-Kuei , WANG Hsiu-Hung , WANG Ruey-Hsia , WU Li-Min
Published: May 2022

Background

Previous studies have evaluated the competency of newly graduated nurses and nurses. However, most of the instruments used include a large number of items that make completing them a time-consuming process. A brief instrument may be more acceptable and feasible for use in these evaluations.

Purpose

This study was designed to develop the brief capstone core competency (CCC or 3C) scale and validate its effectiveness in evaluating the academic and practical performance of nursing students enrolled in a bachelor's degree program.

Methods

A cross-sectional study was conducted. The 3C scale was developed in two phases. In Phase I, the items were summed from literature reviews, an expert panel, known-groups validity, test–retest reliability, internal consistency reliability, and exploratory factor analysis. In Phase II, the efficacy of the instrument was confirmed using confirmative factor analysis. Five hundred ninety-six participants participated in the first phase, and 520 participants participated in the second phase. The study period was 2016–2017.

Results

The 3C scale includes 24 items distinguished into a three-component structure that accounts for 67.85% of the total variance. The three components include nursing intelligence, nursing humanity, and nursing career. The 3C scale was found to have high levels of internal consistency reliability (.97) and test–retest stability reliability (r = .97). A significant statistical difference in the performance level was examined between senior and junior nursing students. The hypothesized three-factor model fit index showed χ2/df = 1338.25/249, p < .001, goodness-of-fit index = .82, comparative fit index = .90, root mean square error of approximation = .09, and standardized root mean square residual = .06. The participants were found to have excellent nursing humanity competency.

Conclusions

The developed 3C scale exhibited satisfactory reliability and validity for use with nursing students. The 3C scale may be used to evaluate the performance of nursing students during their learning process, and the results may be used to evaluate changes in educational outcomes.
Hematic Antegrade Repriming Reduces Emboli on Cardiopulmonary Bypass: A Randomized Controlled Trial
Authors: Blanco-Morillo Juan , Salmerón Martínez Diego , Morillo-Cuadrado Daniel Vicente , Arribas-Leal Jose María , Puis Luc , Verdú-Verdú Alicia , Martínez-Molina Mercedes , Tormos-Ruiz Encarnación , Sornichero-Caballero Angel , Ramírez-Romero Pablo , Farina Piero , Cánovas-López Sergio
Published: May 2022

Particulate and gaseous microemboli (GME) are side effects of cardiac surgery that interfere with postoperative recovery by causing endothelial dysfunction and vascular blockages. GME sources during surgery are multiple, and cardiopulmonary bypass (CPB) is contributory to this embolic load. Hematic antegrade repriming (HAR) is a novel procedure that combines the benefits of repriming techniques with additional measures, by following a standardized procedure to provide a reproducible hemodilution of 300 ml. To clarify the safety of HAR in terms of embolic load delivery, a prospective and controlled study was conducted, by applying Doppler probes to the extracorporeal circuit, to determine the number and volume of GME released during CPB. A sample of 115 patients (n = 115) was considered for assessment. Both groups were managed under strict normothermia, and similar clinical conditions and protocols, receiving the same open and minimized circuit. Significant differences in GME volume delivery (control group [CG] = 0.28 ml vs. HAR = 0.08 ml; p = 0.004) and high embolic volume exposure (>1 ml) were found between the groups (CG = 30.36% vs. HAR = 4.26%; p = 0.001). The application of HAR did not represent an additional embolic risk and provided a four-fold reduction in the embolic volume delivered to the patient (coefficient, 0.24; 95% CI, 0.08–0.72; p = 0.01), which appears to enhance GME clearance of the oxygenator before CPB initiation.
Necrosis on pre-radiotherapy 18F-FDG PET/CT is a predictor for complete metabolic response in patients with non-small cell lung cancer
Authors: Eren Gülnihan , Kupik Osman
Published: May 2022

To investigate necrosis on pre-radiotherapy (RT) 18F-FDG PET/CT (PETNECROSİS) as a predictor of complete metabolic response (CMR) in patients with non-small cell lung cancer (NSCLC).

We evaluated patients with inoperable stage I–III NSCLC who underwent pre- and post-radiotherapy 18F-FDG PET/CT. The relationship between CMR and PETNECROSIS, SUVmax, gross tumor volume calculated with 18F-FDG PET/CT (GTVPET-CT), tumor size, histology, metabolic tumor volume (MTV), and RT dose was assessed using logistic regression analysis. To evaluate necrosis on 18F FDG PET/CT, we drew a region of interest (ROI) in the area showing visually very low/or no fluorodeoxyglucose (FDG) uptake on PET images. If the SUVmax was lower than the blood pool SUVmax and showed significantly lower attenuation (10–30 Hounsfield units [HU]) from the surrounding tissue on non-intravenous contrast-enhanced low-dose correlative CT, we defined it as necrotic (PETNECROSİS).

Fifty-three patients were included in this study. The mean age was 68.1 ± 9.8 years. Twenty-one patients had adenocarcinoma, and 32 had squamous cell carcinoma. All parameters were independent of histologic status. Multivariate logistic regression analysis showed that SUVmax ≤11.6 vs >11.6, (P = .003; OR, 7.670, 95CI%: 2.013–29.231) and PETNECROSİS absence/presence were independent predictors for CMR (P = .028, OR: 6.704, 95CI% 1.214–30.394).

The necrosis on 18F FDG PET/CT and SUVmax > 11.6 could be an imaging marker for the complete metabolic response after definitive chemoradiotherapy or definitive RT alone in patients with NSCLC.
Lymphoepithelial cyst in the palatine tonsil
Authors: Moon Jae Yeon , Kim Namkyun , Jeong Ji Yun , Kim Jung Soo , Heo Sung Jae
Published: May 2022

Rationale:

Lymphoepithelial cyst of the oral cavity is very rare. Most intraoral lymphoepithelial cysts are observed in the floor of the mouth and very few cases have been reported of its occurrence in the palatine tonsil.

Patient concerns:

A 37-year-old healthy woman with no remarkable medical history visited our department with a complaint of frequent tonsillitis.

Interventions:

On endoscopic examination, yellowish mass was observed in the palatine tonsil and removed via an intraoral approach. The mass was completely removed with the left palatine tonsil.

Diagnoses & Outcomes:

Histopathological examination and immunohistochemical staining confirmed a Lymphoepithelial cyst.

Lessons:

Lymphepithelial cysts of the palatine tonsils are extremely rare and are easily overlooked because there are few reported cases. Therefore, care must be taken when examining the tonsil mass.
Precise extraction of impacted supernumerary tooth in the maxillary anterior region with a digital guide plate
Authors: Zhu Fangyong , Hou Deqiang , Zhou Chen , Chen Zhifei , Cao Yannan , Ji Lian , Zou Jianming , Xu Yanhua
Published: May 2022

Rationale:

Removal of impacted supernumerary teeth requires precision and accuracy to prevent iatrogenic injury to important anatomical structures during dental surgery and to improve postoperative healing.

Patient concerns:

A 12-year-old girl visited our department for the assessment and management of her deviated front teeth.

Diagnosis:

Impacted supernumerary tooth extraction in the maxillary anterior region.

Interventions:

The digital guide plate was fabricated after the integration of cone beam computed tomography data with that obtained from scanning the patient's dental model. Impacted supernumerary tooth extraction was performed.

Outcomes:

The use of the digital guide plate and planting instruments made the removal of the impacted supernumerary tooth less invasive, faster, and more accurate, whereas the wound was smaller, and the patient experience more comfortable.

Lessons:

Combining the digital guide plate with planting instruments offers a useful aid for the removal of impacted supernumerary teeth among the maxillary anterior region and is, thus, worth promoting.
Effect of ketorolac tromethamine combined with dezocine prior administration on hemodynamics and postoperative analgesia in patients undergoing laparoscopic hernia repair
Authors: Wu Yu , Cai Zenghua , Li Yanli , Kang Yuling , Fu Bohan , Wang Jinbao
Published: May 2022

Objective:

To observe the effect of Ketorolac tromethamine combined with dezocine prior administration on hemodynamics and postoperative sedation in patients undergoing laparoscopic hernia repair.

Methods:

100 male patients aged 60 to 80 years old, a line to elective laparoscopic inguinal hernia repair, were randomly divided into four groups: control group (Group A) and dezocine group (Group B), ketorolac tromethamine group (Group C), ketorolac tromethamine combined with dezocine group (Group D). Patients were administrated with 0.1 mg/kg dezocine in Group B, 0.5 mg/kg ketorolac in Group C, 0.1 mg/kg dezocine, and 0.5 mg/kg ketorolac in Group D, and with an equal dose of normal saline in group A. The heart rate (HR) and mean arterial pressure (MAP) of patients in 4 groups were recorded at each time point as follows, T0 (enter the operating room), T1 (before skin resection), 10 min after pneumoperitoneum (T2), mesh placement (T3), and laryngeal mask extraction (T4). Operation time, awakening time (time from drug withdrawal to consciousness recovery), the dosage of propofol, sufentanil, remifentanil, and intraoperative vasoactive drug dosage were recorded to compare. Visual analog scale score and sedation Ramsay score were evaluated 1, 6, 12, and 24 hours after extubation.

Results:

There was no significant difference in operation time, anesthesia recovery time, sufentanil dosage, and vasoactive drugs among all groups. The amount of propofol in Group B and D was less than that in Group A and C (P < .05), and there was no difference between Group B and D, A and C (P > .05). The amount of remifentanil in Group B, C, and D was less than that in Group A (P < .05), and Group D was less than B and C (P < .05). After extubation, HR and MAP were significantly higher than before (P < .05). Compared with T0, HR and MAP increased in each group at T4, but MAP and HR in Group D increased the least (P < .05). There were significant differences between Group B, C, D, and A, MAP and HR fluctuated little during extubation (P < .05), but there was a significant difference between Group D and B, C (P < .05). Visual analog scale scores of Group B, C, and D were lower than those of A at 1, 6, and 12 hours after surgery (P < .05), and there was a significant difference between Group D, and B, C (P < .05). Ramsay scores in Group B and D were higher than those in A and C at 1 and 6 hours after the operation (P < .05). There was no difference in the incidence of adverse reactions among groups.

Conclusion:

The prophylactic use of ketorolac tromethamine and dezocine before laparoscopic inguinal hernia repair can reduce hemodynamic disorder during anesthesia recovery, increase postoperative sedative and analgesic effects.
Miller Fisher syndrome after COVID-19 vaccination: Case report and review of literature
Authors: Siddiqi Ahsun Rizwan , Khan Tehrim , Tahir Muhammad Junaid , Asghar Muhammad Sohaib , Islam Md. Saiful , Yousaf Zohaib
Published: May 2022

Rationale:

Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barre syndrome, classically diagnosed based on the clinical triad of ataxia, areflexia, and ophthalmoplegia. MFS is usually preceded by viral infections and febrile illness; however, only a few cases have been reported after vaccinations.

Patient concerns:

A 53-year-old hypertensive male presented with a 2-day history of progressive ascending paralysis of the lower limbs along with diplopia and ataxia, 8 days after the first dose of the Sinovac–Coronavac coronavirus disease 2019 (COVID-19) vaccination, with no prior history of any predisposing infections or triggers.

Diagnoses:

Physical examination showed moderate motor and sensory loss with areflexia in the lower limbs bilaterally. Routine blood investigations and radiological investigations were unremarkable. Cerebrospinal fluid analysis showed albuminocytologic dissociation and nerve conduction studies revealed prolonged latencies with reduced conduction velocities. The diagnosis of MFS was established based on the findings of physical examination, cerebrospinal fluid analysis, and nerve conduction studies.

Interventions:

A management plan was devised based on intravenous immunoglobulins, pregabalin, and physiotherapy. However, due to certain socioeconomic factors, the patient was managed conservatively with regular physiotherapy sessions.

Outcomes:

Follow-up after 6 weeks showed remarkable improvement, with complete resolution of symptoms 10 weeks after the discharge.

Lessons:

This case suggests that MFS is a rare adverse effect after COVID-19 vaccination and additional research is required to substantiate a temporal association. Further studies are needed to understand the pathophysiology behind such complications to enhance the safety of COVID-19 vaccinations in the future.
Chronic Obstructive Pulmonary Disease and Social Determinants of Health
Authors: Fasolino Tracy , Koci Anne
Published: May 2022

Chronic obstructive pulmonary disease remains a challenging epidemic across the United States. This serious illness impacts nearly twice as many individuals in the rural area compared with urban counterparts. As the disease progresses, the symptom burden and needs of the patient and caregivers escalate. Access gaps to services, such as hospice and palliative care, and the social determinants of health found in Appalachia may lead to marginalization and social injustice. Defined as the condition of being peripheralized based upon one's social margins of identity, associations, and/or environment, marginalization impacts health outcomes and quality of life. This article explores the triple threat of marginalization for patients with chronic obstructive pulmonary disease living in rural Appalachia. By recognizing marginalization and designing initiatives to reduce the impact, hospice and palliative care nurses serve as advocates and leaders to influence systemic change through partnerships with key policymakers and legislators.
Leader Standard Work
Authors: Kupec Stephanie , Reinemann Michael , Selley Victoria H. , Graves Elsie , Carlson Jestin N.
Published: May 2022

Although several methods have been proposed to help reduce inefficiencies in healthcare, these may be inaccessible or impractical for leaders to implement given their complexity. Leader Standard Work (LSW) has been successfully utilized in other industries to help improve the efficiencies of leaders by providing individual, manageable concepts that leaders can rapidly implement to effect change. This column provides a brief overview of LSW and how it may be used to leadership effectiveness and, ultimately, healthcare.
Newly Licensed Nurse Perceived Incivility: A Valid and Reliable Assessment Tool
Authors: Agee Emily , Boots Brenda K. , Cantu Chelcia , Hunley Amber N. , Mains Brandi C. , McElroy Susan , Oertle Dena L. , Olney Adrienne , Pontius Camie , Schotte Amy L.
Published: May 2022

OBJECTIVE

To test the instrument, Nursing Student Perception of Civil and Uncivil Behaviors (NSPCUB) in newly licensed nurses' (NLNs') to create a credible measure of NLNs' perceptions of civil/uncivil behaviors by RNs.

BACKGROUND

Uncivil behaviors in the workplace result in poor morale, absenteeism, and turnover. When targeted toward NLNs, the outcome of these behaviors can affect not only a job but a future career.

METHODS

A convenience sample of NLNs from 3 cohorts completed the modified NSPCUB-NLN 12-item survey. Exploratory factor analysis and reliability statistics were conducted. Concurrent validity was evaluated.

RESULTS

Exploratory factor analysis identified passive and active incivility subscales with high reliability (overall Cronbach's α = 0.917). Participants expressing positive experiences scored higher than those with negative experiences (P < 0.0001), supporting instrument validity.

CONCLUSIONS

This study demonstrated that the NSPCUB-NLN is a valid and reliable instrument for use with NLNs. This will assist nurse leaders in evaluating unit cultures for incivility, guiding interventions for a healthy work environment.
Opioid agonist treatment improves progression through the HIV cascade of care among people living with HIV who use unregulated opioids
Authors: Juwono Stephen , Milloy M.-J. , Choi JinCheol , Fairbairn Nadia , Nolan Seonaid , Socías M. Eugenia
Published: May 2022

Objectives:

Opioid agonist treatment (OAT) has been shown to improve certain HIV-related treatment measures among people with HIV (PHIV) with opioid use disorder (OUD). However, there is limited data on the impacts of OAT along the whole HIV cascade of care.

Design and Methods:

Using data from an ongoing cohort of PHIV who use drugs in Vancouver, Canada, we used cumulative link mixed-effects models to estimate the independent effect of OAT on achieving progressive steps in the HIV cascade among participants using unregulated opioids daily, after adjusting for confounders.

Results:

Between 2005 and 2017, we recruited 639 PHIV regularly using opioids (median age 42 years, 59% male, 56% White), of whom 70% were on OAT at their baseline visit. Engagement in OAT showed a nonsignificant trend with higher linkage to HIV care (adjusted partial proportional odds ratio [APPO] = 1.75, 95% confidence interval [CI]: 0.83–3.69), and significantly higher cumulative odds of successfully achieving subsequent HIV cascade steps: on ART (APPO = 3.85, 95% CI: 2.33–6.37); adherent to ART (APPO = 3.15, 95% CI: 2.15–4.62); and HIV viral suppression (APPO = 2.18, 95% CI: 1.51–3.14).

Conclusions:

This study found a high level of OAT engagement among PHIV using unregulated opioids and that OAT engagement resulted in significantly increased progression through some of the higher steps of the HIV cascade. While these findings are encouraging, they highlight the need to reach populations off OAT to maximize the clinical and community-level benefits of ART.
Adverse perinatal outcomes associated with HAART and monotherapy: systematic review and meta-analysis
Authors: Portwood Clara , Sexton Harriet , Kumarendran Mary , Brandon Zoe , Kirtley Shona , Hemelaar Joris
Published: May 2022

Objectives:

Assess adverse perinatal outcomes in women living with HIV (WLHIV) receiving HAART or zidovudine (ZDV) monotherapy, compared with antiretroviral therapy (ART)-naive WLHIV and HIV-negative women.

Design:

Systematic review and meta-analysis.

Methods:

We conducted a systematic literature review by searching PubMed, CINAHL, Global Health, and EMBASE for studies published during 1 January 1980 to 20 April 2020. We included studies reporting on the association of pregnant WLHIV receiving HAART or ZDV monotherapy with 11 perinatal outcomes: preterm birth (PTB), very PTB, spontaneous PTB (sPTB), low birth weight (LBW), very LBW, term LBW, preterm LBW, small for gestational age (SGA), very SGA (VSGA), stillbirth, and neonatal death. Random-effects meta-analyses were conducted.

Results:

Sixty-one cohort studies assessing 409 781 women were included. WLHIV receiving ZDV monotherapy were associated with a decreased risk of PTB [relative risk 0.70, 95% confidence interval (CI) 0.62–0.79] and LBW (0.77, 0.67–0.88), and comparable risk of SGA, compared with ART-naive WLHIV. WLHIV receiving ZDV monotherapy had a comparable risk of PTB and LBW, and an increased risk of SGA (1.16, 1.04–1.30) compared with HIV-negative women. In contrast, WLHIV receiving HAART were associated with a comparable risk of PTB and LBW, and increased risk of SGA (1.38, 1.09–1.75), compared with ART-naive WLHIV. WLHIV receiving HAART were associated with an increased risk of PTB (1.55, 1.38–1.74), sPTB (2.09, 1.48–2.96), LBW (1.79, 1.51–2.13), term LBW (1.88, 1.23–2.85), SGA (1.80,1.34–2.40), and VSGA (1.22, 1.10–1.34) compared with HIV-negative women.

Conclusion:

Pregnant WLHIV receiving HAART have an increased risk of a wide range of perinatal outcomes compared with HIV-negative women.
Incident depression among Medicare beneficiaries with disabilities and HIV
Authors: Yu Xiaoying , Baillargeon Jacques , Berenson Abbey B. , Westra Jordan R. , Giordano Thomas P. , Kuo Yong-Fang
Published: May 2022

Objective:

Despite disproportionally high prevalence of HIV and depression in persons with disabilities, no data have been published on the incidence and correlates of depression in Medicare beneficiaries with disabilities. We assessed the effect of HIV infection on developing depression in this population.

Design:

We conducted a retrospective matched cohort study using a 5% sample of Medicare beneficiaries who qualified for disability coverage (1996–2015).

Methods:

Beneficiaries with incident (n = 2438) and prevalent (n = 5758) HIV were individually matched with beneficiaries without HIV (HIV−, n = 20 778). Fine-Gray models with death as a competing risk were used to assess the effect of HIV status, age, and cohort period on developing depression by sex strata.

Results:

Beneficiaries with HIV had a higher risk of developing depression within 5 years (P < 0.0001). Sex differences were observed (P < 0.0001), with higher subdistribution hazard ratios (sHR) in males with HIV compared with controls. The risk decreased with age (P < 0.0001) and increased in recent years (P < 0.0001). There were significant age-HIV (P = 0.004) and period-HIV (P = 0.006) interactions among male individuals, but not female individuals. The sHR was also higher within the first year of follow-up among male individuals, especially those with incident HIV.

Conclusion:

Medicare enrollees with disabilities and HIV had an increased risk of developing depression compared to those without HIV, especially among males and within the first year of HIV diagnosis. The HIV-depression association varied by sex, age, and cohort period. Our findings may help guide screening and comprehensive management of depression among subgroups in this vulnerable population.
Proof of concept study for a closed ex vivo limb perfusion system for 24-hour subnormothermic preservation using acellular perfusate
Authors: Veraza Rafael J. , Lopez Riley , Parry Olivia , Sleeter Justin , Cano Isabella , Bohara Udipta , Merlo Jaclyn , Jessop Israel , Weitzel Erik , Bunegin Leonid
Published: May 2022

BACKGROUND

The two approaches to vascularized tissue machine perfusion use either the open (nonpressurized) or closed (pressurized) perfusion system. Most studies describing isolated limb perfusion preservation rely on open perfusion systems and report tissue edema exceeding 40% after 12 to 14 hours of preservation. A variant of machine perfusion places the limb and perfusate into a reservoir closed to atmosphere. It is hypothesized that the reservoir pressure, acting as a transmural pressure, has the advantage of reducing edema formation by counteracting the hydrostatic pressure gradient from the perfusion pressure. This proof-of-concept study aim was to demonstrate feasibility of the Universal Limb Stasis System for Extended Storage (ULiSSES) device (closed, vertical perfusion system) to preserve forelimbs of Sus scrofa swine for 24 hours of subnormothermic perfusion compared with an open, horizontal perfusion system. The ULiSSES is a compact, practical device that applies pulsatile, pressurized perfusion through the novel use of a diaphragm pump powered by compressed oxygen.

METHODS

Forelimbs from swine were preserved in ULiSSES device (closed perfusion system) (n = 9) and in an open perfusion system (n = 4) using subnormothermic modified Krebs-Henseleit solution. Physiological parameters were measured at the start and every 3 hours for 24 hours. Limbs were weighed before and after perfusion to compare weight gain. Edema and cellular integrity were evaluated using histopathology pre and post perfusion.

RESULTS

Closed perfusion system showed superiority compared with the open perfusion system in terms of oxygen consumption, reduction in vascular resistance, and overall tissue integrity. The closed perfusion system demonstrated a 21% reduction in weight gain compared with the open perfusion system and significantly reduced intracellular edema.

CONCLUSION

The ULiSSES closed, pressurized perfusion technology has translatable military applications with the potential to preserve porcine limbs for 24 hours with improved results compared with an open perfusion system.
County-level Differences in Liver-related Mortality, Waitlisting, and Liver Transplantation in the United States
Authors: Cannon Robert M. , Nassel Ariann , Walker Jeffery T. , Sheikh Saulat S. , Orandi Babak J. , Shah Malay B. , Lynch Raymond J. , Goldberg David S. , Locke Jayme E.
Published: May 2022

Background.

Much of our understanding regarding geographic issues in transplantation is based on statistical techniques that do not formally account for geography and is based on obsolete boundaries such as donation service area.

Methods.

We applied spatial epidemiological techniques to analyze liver-related mortality and access to liver transplant services at the county level using data from the Centers for Disease Control and Prevention and Scientific Registry of Transplant Recipients from 2010 to 2018.

Results.

There was a significant negative spatial correlation between transplant rates and liver-related mortality at the county level (Moran’s I, –0.319; P = 0.001). Significant clusters were identified with high transplant rates and low liver-related mortality. Counties in geographic clusters with high ratios of liver transplants to liver-related deaths had more liver transplant centers within 150 nautical miles (6.7 versus 3.6 centers; P < 0.001) compared with all other counties, as did counties in geographic clusters with high ratios of waitlist additions to liver-related deaths (8.5 versus 2.5 centers; P < 0.001). The spatial correlation between waitlist mortality and overall liver-related mortality was positive (Moran’s I, 0.060; P = 0.001) but weaker. Several areas with high waitlist mortality had some of the lowest overall liver-related mortality in the country.

Conclusions.

These data suggest that high waitlist mortality and allocation model for end-stage liver disease do not necessarily correlate with decreased access to transplant, whereas local transplant center density is associated with better access to waitlisting and transplant.
Evaluating how management policies affect red wolf mortality and disappearance
Authors: Santiago-Ávila Francisco J. , Agan Suzanne , Hinton Joseph W. , Treves Adrian
Published: May 2022

Poaching is the major cause of death for large carnivores in several regions, contributing to their global endangerment. The traditional hypothesis used in wildlife management (killing for tolerance) suggests reducing protections for a species will decrease poaching. However, recent studies suggest reducing protections will instead increase poaching (facilitated illegal killing) and its concealment (facilitated cryptic poaching). Here, we build survival and competing risk models for mortality and disappearances of adult collared red wolves (Canis rufus) released in North Carolina, USA from 1987 to 2020 (n= 526). We evaluated how changes in federal and state policies protecting red wolves influenced the hazard and incidence of mortality and disappearance. We observed substantial increases in the hazard and incidence of red wolf reported poaching, and smaller increases in disappearances, during periods of reduced federal and state protections (including liberalizing hunting of coyotes,C. latrans); white-tailed deer (Odocoileus virginianus) and American black bear (Ursus americanus) hunting seasons; and management phases. Observed increases in hazard (85–256%) and incidence of reported poaching (56–243%) support the ‘facilitated illegal killing' hypothesis. We suggest improving protective policies intended to conserve endangered species generally and large carnivores in particular, to mitigate environmental crimes and generally improve the protection of wild animals.