bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between hypogammaglobulinaemia and severe infections during induction therapy in ANCA-associated vasculitis: from J-CANVAS study
Authors: Omura Satoshi , Kida Takashi , Noma Hisashi , Sunaga Atsuhiko , Kusuoka Hiroaki , Kadoya Masatoshi , Nakagomi Daiki , Abe Yoshiyuki , Takizawa Naoho , Nomura Atsushi , Kukida Yuji , Kondo Naoya , Yamano Yasuhiko , Yanagida Takuya , Endo Koji , Hirata Shintaro , Matsui Kiyoshi , Takeuchi Tohru , Ichinose Kunihiro , Kato Masaru , Yanai Ryo , Matsuo Yusuke , Shimojima Yasuhiro , Nishioka Ryo , Okazaki Ryota , Takata Tomoaki , Ito Takafumi , Moriyama Mayuko , Takatani Ayuko , Miyawaki Yoshia , Ito-Ihara Toshiko , Yajima Nobuyuki , Kawaguchi Takashi , Fukuda Wataru , Kawahito Yutaka
Published: March 2023

Objectives

To investigate the association between decreased serum IgG levels caused by remission-induction immunosuppressive therapy of antineutrophil cytoplasmic antibody-associated vasculitis (AAV) and the development of severe infections.

Methods

We conducted a retrospective cohort study of patients with new-onset or severe relapsing AAV enrolled in the J-CANVAS registry, which was established at 24 referral sites in Japan. The minimum serum IgG levels up to 24 weeks and the incidence of severe infection up to 48 weeks after treatment initiation were evaluated. After multiple imputations for all explanatory variables, we performed the multivariate analysis using a Fine–Gray model to assess the association between low IgG (the minimum IgG levels <500 mg/dl) and severe infections. In addition, the association was expressed as a restricted cubic spline (RCS) and analysed by treatment subgroups.

Results

Of 657 included patients (microscopic polyangiitis, 392; granulomatosis with polyangiitis, 139; eosinophilic granulomatosis with polyangiitis, 126), 111 (16.9%) developed severe infections. The minimum serum IgG levels were measured in 510 patients, of whom 77 (15.1%) had low IgG. After multiple imputations, the confounder-adjusted hazard ratio of low IgG for the incidence of severe infections was 1.75 (95% confidence interval: 1.03–3.00). The RCS revealed a U-shaped association between serum IgG levels and the incidence of severe infection with serum IgG 946 mg/dl as the lowest point. Subgroup analysis showed no obvious heterogeneity between treatment regimens.

Conclusion

Regardless of treatment regimens, low IgG after remission-induction treatment was associated with the development of severe infections up to 48 weeks after treatment initiation.
Socio-economic framework for the design of national household insolvency systems
Authors: Wang Xiaojing , Ward Anne Marie
Published: March 2023

Lessons learned in the aftermath of the Financial Crisis of 2008 include that long, punitive household insolvency regimes have a negative societal impact, increase the potential for financial instability and hamper national economic recovery. We propose the Socio-Economic Framework for Household Insolvency System Design as a regulatory mechanism that aims to control national household debt and productivity levels. The system facilitates an informal resolution of the conflict between over-indebted households and their creditors. When this is not possible, the system grants immediate relief to no-income, no-assets and ‘honest’ households, that experienced over-indebtedness because of an external negative shock, such as a medical emergency. Finally, when the household does not qualify for immediate relief, the system allocates the costs of insolvency between the household and creditors, based on responsibility for the over-indebtedness. This reduces the moral hazard.
Basic Fibroblast Growth Factor Promotes Mesenchymal Stem Cell Migration by Regulating Glycolysis-Dependent β-Catenin Signaling
Authors: Lu Junhou , Zhang Yu , Wang Dongyan , Xu Xiaojing , Xu Jianwei , Yang Xinyu , Qian Hongxiang , Zhang Huanxiang
Published: March 2023

Migration of mesenchymal stem cells (MSCs) to the site of injury is crucial in transplantation therapy. Studies have shown that cell migration is regulated by the cellular microenvironment and accompanied by changes in cellular metabolism. However, limited information is available about the relationship between MSC migration and cellular metabolism. Here, we show that basic fibroblast growth factor (bFGF) promotes the migration of MSCs with high levels of glycolysis and high expression of hexokinase 2 (HK2), a rate-limiting enzyme in glycolysis. The enhancement of glycolysis via the activation of HK2 expression promoted the migration of MSCs, whereas the inhibition of glycolysis, but not of oxidative phosphorylation, inhibited the bFGF-induced migration of these cells. Furthermore, bFGF enhanced glycolysis by increasing HK2 expression, which consequently promoted β-catenin accumulation, and the inhibition of glycolysis inhibited the bFGF-induced accumulation of β-catenin. When the accumulation of glycolytic intermediates was altered, phosphoenolpyruvate was found to be directly involved in the regulation of β-catenin expression and activation, suggesting that bFGF regulates β-catenin signaling through glycolytic intermediates. Moreover, transplantation with HK2-overexpressing MSCs significantly improved the effect of cell therapy on skull injury in rats. In conclusion, we propose a novel glycolysis-dependent β-catenin signaling regulatory mechanism and provide an experimental and theoretical basis for the clinical application of MSCs.
Peptide RL‐QN15 promotes regeneration of epidermal nerve fibers and recovery of sensory function in diabetic skin wounds
Authors: Wu Yutong , Wang Ying , Fu Zhe , Sun Huiling , Liu Yixiang , Li Chao , Wang Yinglei , Liu Naixin , Huang Yubing , Yin Saige , Guo Kun , Feng Chengan , Tang Jing , He Li , Yang Ying , Yang Xinwang
Published: March 2023

Epidermal nerve fiber regeneration and sensory function are severely impaired in skin wounds of diabetic patients. To date, however, research on post‐traumatic nerve regeneration and sensory reconstruction remains scarce, and effective clinical therapeutics are lacking. In the current study, localized treatment with RL‐QN15, considered as a drug candidate for intervention in skin wounds in our previous research, accelerated the healing of full‐thickness dorsal skin wounds in diabetic mice and footpad skin wounds in diabetic rats. Interestingly, nerve density and axonal plasticity in the skin wounds of diabetic rats and mice, as well as plantar sensitivity in diabetic rats, were markedly enhanced by RL‐QN15 treatment. Furthermore, RL‐QN15 promoted the proliferation, migration, and axonal length of neuron‐like PC12 cells, which was likely associated with activation of the phosphatidylinositol‐3 kinase/protein kinase B (PI3K/Akt) signaling pathway. The therapeutic effects of RL‐QN15 were partially reduced by blocking the PI3K/Akt signaling pathway with the inhibitor LY294002. Thus, RL‐QN15 showed positive therapeutic effects on the distribution of epidermal nerve fibers and stimulated the recovery of sensory function after cutaneous injury. This study lays a solid foundation for the development of RL‐QN15 peptide‐based therapeutics against diabetic skin wounds.
Preparing Nurses to Use Electronic Health Records
Authors: Velez Kimberly , John Jaimy
Published: March 2023

Nursing schools can better integrate documentation skills training.
Liberal Fasting Policy Before Surgery
Authors: Rosenberg Karen
Published: March 2023

According to this study:

In a quality improvement study of adults scheduled for anesthesia, a liberal fasting policy was associated with a clinically relevant reduction in fasting time and improved patient well-being.
Take Off the Mask: Getting Real About Depression, Trauma, and Loss
Authors: Smith Nikki Racquel
Published: March 2023

A nurse and mother learns to be present, not perfect.
Distal Radius Salter–Harris II Fracture Loss of Reduction: The Importance of Coronal Plane Angulation in Older Children
Authors: Rivera Asdrubal E. , Welbeck Arakua , Cummings Jason L. , Goldfarb Charles A. , Hosseinzadeh Pooya
Published: March 2023

Objectives:

To assess factors affecting the loss of reduction (LOR) in a large cohort of children with Salter–Harris Type II (SH II) distal radius physeal fractures treated with closed reduction.

Design:

Retrospective chart review.

Setting:

Pediatric Level I Trauma Center.

Patients/Participants:

A total of 141 pediatric patients (73% male, average age: 12.15 ± 2.55 years) that had undergone closed reduction and casting for distal radius physeal fractures from 2006 to 2019 were included in this study.

Intervention:

Closed reduction and casting.

Main Outcome Measurements:

Five different radiographic measurements were analyzed at 4 different time points. Follow-up radiographs were assessed in relation to initial reduction. LOR was defined as >5 degrees change of angulation on PA radiographs, >10 degrees change of angulation on lateral radiographs, and/or >25% translation on PA or lateral radiographs.

Results:

LOR was seen in 28.4% of the patients, most often (68%) in the first 2 weeks after initial reduction. Seven (17.5%) of these patients (average age: 15.2 ± 2.0 years) were treated surgically with closed reduction and percutaneous pinning (CRPP). Patients undergoing CRPP for LOR were an average of 3.4 years older (P < 0.001) than those who underwent nonoperative treatment of LOR. Patients with initial angulation more than 5 degrees on the PA view to be twice as likely to have LOR (P = 0.03).

Conclusions:

LOR was seen in nearly 1/3 of these patients. Patients with initial higher degree of angulation on the coronal plane are at higher risk for LOR. Age, not the degree of angulation, is the main predictor for potential surgical treatment.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Where Are We in 2022? A Summary of 11,000 Open Tibia Fractures Over 4 Decades
Authors: Castillo Isaac A. , Heiner Jacob A. , Meremikwu Ramzy I. , Kellam James , Warner Stephen J.
Published: March 2023

Objectives:

To determine the infection and nonunion rates for open tibia fracture treatment over the past 4 decades since the introduction of the Gustilo–Anderson (GA) open fracture classification.

Data Sources:

PubMed, Scopus, CINAHL, and Cochrane databases were reviewed using the PRISMA checklist for articles between 1977 and September 2018.

Study Selection:

One hundred sixty-one articles meeting the following inclusion criteria: English language, published between 1977 and 2018, reported infection rates, reported nonunion rates, and fractures classified by the GA open fracture criteria were selected.

Data Extraction:

All articles were thoroughly evaluated to extract infection and nonunion data for open tibia fractures.

Data Synthesis:

Due to variability in the data reviewed, statistical evaluation could not be reliably done.

Results:

11,326 open tibia fractures were reported with 17% type I, 25.2% type II, 25.3% type IIIA, and 32.5% type IIIB/C. The average infection rate over 4 decades was 18.3%, with 24.3% superficial, 11.2% deep, and 14.7% pin tract. The infection rate by decade was 14% for 1977–1986, 16.2% for 1987–1996, 20.5% for 1997%–2006%, and 18.1% from 2007 to 2017. The overall nonunion rate was 14.1%. The nonunion rate was 13% for 1977–1986, 17% for 1987–1996, 12.8% for 1997%–2006%, and 12.3% for 2007–2017.

Conclusions:

This in-depth summary has demonstrated that the percentage rate for infections and nonunion has remained similar over the past 40 years.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Robotics Coupled With Navigation for Pediatric Spine Surgery: Initial Intraoperative Experience With 162 Cases
Authors: Welch Nicole , Mota Frank , Birch Craig , Hutchinson Lauren , Hedequist Daniel
Published: March 2023

Background:

This study assesses intraoperative efficacy, accuracy, and complications of pedicle screw placement using robotic-assisted navigation (RAN) in pediatric spine surgery.

Methods:

A retrospective review of patients who underwent spine deformity surgery using RAN at a single pediatric institution from 2019 to 2021 was conducted. Patient demographics, perioperative metrics, screw execution and accuracy, technical difficulties, and other outcomes were summarized. In cases with postoperative computed tomography scans, screws were classified using the Gertzbein and Robbins classification scale. Fisher exact tests were used to assess the relationship between procedural changes and lateral screw malposition.

Results:

One hundred sixty-two cases with an average patient age of 15.1 years (range, 4 to 31 y) were reviewed. The most common diagnosis was adolescent idiopathic scoliosis (n=80) with an average major curve of 65 degrees. Of 1467 screws attempted, 1461 were executed successfully (99.6%). All failures were in Type D pedicles and were lateral deviations recognized with routine intraoperative fluoroscopy. In cases with postoperative computed tomography imaging, 100% of screws (n=197) were placed with complete containment (Grade A). Remaining screws were graded as accurate by mirroring fluoroscopy and planned computer software positions. In 4% of cases, loss of registration was detected by a safety check before drilling at the planned level. There were no neurological deficits or returns to the operating room. Two changes occurred as part of the learning curve associated with this technique. (1) Adoption of a high-speed navigated drill: Change 1 (last 74 cases). (2) Drilling all pilot holes robotically first, then placing screws within the robotically established tracts to avoid motion and subsequent registration disruption: Change 2 (last 39 cases). Change 1 was less likely to result in screw malposition as no screws skived lateral with the technique (P=0.03). Change 2 trended toward statistical significance for avoidance of screw malposition and loss of registration, as no loss of registration occurred after adopting this technique.

Conclusion:

This study highlights the safety and screw accuracy associated with the use of RAN in pediatric patients.

Level of Evidence:

Level III.
Declining Rates of Legg–Calvé–Perthes Surgery in the United States: National Trends Using the Kids’ Inpatient Database and Pediatric Health Information System
Authors: LaGreca Jaren , Nickel Amanda , Finch Michael , Martin Benjamin D. , Laine Jennifer C.
Published: March 2023

Background:

In 2004 and 2008 two large prospective, multicenter studies were published which resulted in improved understanding of operative indications for the treatment of Legg–Calvé–Perthes disease (LCPD) based on patient age, disease severity, and resultant radiographic outcomes. The primary aim of this study is to evaluate the trends in surgical management of LCPD in the United States prior, and subsequent to, the publication of these landmark studies.

Methods:

Cross-sectional retrospective analysis of US pediatric hospitalizations for the surgical management of LCPD was conducted using the Kids’ Inpatient Database from 2000 to 2016. Patients 12 years of age and younger were included who had a primary admission diagnosis of LCPD and a LCPD-related procedure during the hospitalization. Data was subsequently weighted to produce national-level estimates and variables pertaining to patient age group, procedure, demographics, and hospital characteristics were analyzed. In a post hoc analysis, the results of the Kids’ Inpatient Database were also corroborated with the Pediatric Health Information System database.

Results:

A weighted sample of 2786 LCPD surgical admissions met inclusion and exclusion criteria; 11.2% of surgical admissions were patients below 6 years of age, 35.9% were 6 to 8 years of age, and 52.9% were above 8 years of age. There was a significant decrease in admissions for surgical management of LCPD in all age groups over time, however there was no appreciable change in the proportion of LCPD surgical admissions performed among the above 8 to below 12, above 6 to below 8, or below 6 years age groups. Femoral osteotomy remained the most common surgical procedure, while other osteotomy types, including pelvic and unspecified osteotomies involving the hip, decreased over time (P<0.001).

Conclusions:

There is a decreasing rate of hospital admissions for LCPD surgery since 2000, perhaps indicating a decline in incidence of disease. Furthermore, despite evidence supporting LCPD surgical outcomes related to patient age, there has been no change in the proportion of patients undergoing surgery by age group over time.

Level of Evidence:

Level III—retrospective study.
Does Shorter Time to Treatment of Pediatric Supracondylar Humerus Fractures Impact Clinical Outcomes?
Authors: Sullivan Mikaela H. , Wahlig Brian D. , Broida Samuel E. , Larson A. Noelle , Shaughnessy William J. , Stans Anthony A. , Milbrandt Todd A.
Published: March 2023

Background:

Treatment of supracondylar humerus (SCH) fractures within 18 hours of presentation is a tracked quality metric for ranking of pediatric hospitals. This is in contrast with literature that shows time to treatment does not impact outcomes in SCH fractures. We aim to determine whether an 18-hour cutoff for pediatric supracondylar humerus fracture treatment is clinically significant by comparing the complication risks ofpatients on either side of this timepoint. Our hypothesis is that there will be no statistically significant differences based on time to treatment.

Methods:

A retrospective review of clinical outcomes was performed for 472 pediatric patients who underwent surgical management of isolated supracondylar humerus fractures between 1997 and 2022 at a single level I pediatric trauma hospital. The cohort was split based on time to surgery (within or ≥18 h from Emergency Department admission).

Results:

Surgical treatment occurred within 18 hours of arrival in 435 (92.2%) patients and after 18 hours in 37 (7.8%) patients. Mean age was 5.6±2.2 years and 51.5% of patients were female. Gartland fracture classification was type II [n=152 (32.3%)], type III [n=284 (60.3%)], type IV [n=13 (2.8%)], or flexion-type [n=18 (3.8%)]. There were no differences in demographic characteristics or fracture classification between cohorts. Fractures in the ≥18-hour cohort were treated more commonly with 2 pins (62.2% vs. 38.5%, P=0.04). There were no statistically significant differences in open versus closed reduction, utilization of medial pins, or postoperative immobilization between cohorts. We were unable to detect any differences in postoperative complications, including non-union, delayed union, stiffness, malunion, loss of reduction, iatrogenic nerve injury, or infection. This remained true when type II fractures were excluded.

Conclusions:

Using an arbitrary time cutoff of <18 hours does not influence clinical outcomes in the surgical treatment of SCH fractures. This held true when type II fractures were excluded. For this reason, we recommend modification to the USNWR guidelines to decrease emphasis on time-to-treatment of SCH fractures.

Level of Evidence:

Level III
A Case of Bilateral Keratitis and Bilateral Anterior Uveitis Induced by Pembrolizumab
Authors: Fukuoka Hideki , Yoshioka Maya , Kobayashi Hitomi , Okumura Takahiro , Sotozono Chie
Published: March 2023

Purpose:

The purpose of this study was to report a case of bilateral keratitis and bilateral anterior uveitis that occurred at different time points after initiating pembrolizumab therapy.

Case report:

A 70-year-old man was referred to our hospital due to blurred vision and conjunctival injection in his right eye. Initial examination revealed conjunctivalization of the cornea with a corneal ulcer, inflammatory cells in the anterior chamber, and bilateral epiretinal membrane. Because the right-eye symptoms included blurred vision and redness immediately postpembrolizumab administration, a diagnosis of ophthalmic immune-related adverse event (irAE) was made. He was treated with antibiotic and betamethasone eye drops in his right eye. Because skin rashes appeared on his face and upper and lower extremities simultaneous with the ocular symptoms, a diagnosis of a grade 2 dermatological irAE was made based on dermatological findings, and pembrolizumab was discontinued. At 3 weeks postpembrolizumab discontinuation, conjunctival injection with inflammatory cells occurred in his left eye, so a treatment with additional antibiotic and betamethasone eye drops was initiated. At 1 month postpembrolizumab discontinuation, the dermatological irAE (skin rashes) disappeared, with no recurrence of ocular and dermatological irAE for more than 2 years post-treatment.

Conclusions:

Because anterior uveitis is a widely known adverse event of the checkpoint inhibitor pembrolizumab, ophthalmologists need to be aware whether their patients are on the medication and conduct timely follow-up examinations in cases in which new eye symptoms occur.
Characterization of Infectious Keratitis in Opioid Users in a County Hospital Setting
Authors: Lopez Jacqueline B. , Chan Lawrence , Saifee Murtaza , Seitzman Gerami D. , Yung Madeline , Chan Matilda F.
Published: March 2023

Purpose:

The aim of this study was to determine risk factors and clinical course of corneal ulcers in the setting of opioid use.

Methods:

A retrospective cohort study was performed of patients presenting with bacterial or fungal keratitis at a county hospital from 2010 to 2021. Subjects were separated into 3 groups: opioid drug users (heroin, methadone, and fentanyl), nonopioid drug users, and nondrug users. Twenty-four opioid users, 77 nonopioid drug users, and 38 nondrug users were included in the study. Chi-square and t-tests were used to compare hospitalization for corneal ulcer treatment, length of hospitalization, loss to follow-up, final best-corrected visual acuity (BCVA), medication noncompliance, time to ulcer resolution, and visual disability (defined by either the legal limit for driving in California or the federal limit for blindness).

Results:

Opioid users had higher rates of unemployment (P = 0.002), homelessness (P = 0.018), and psychiatric conditions (P = 0.024) compared with nonopioid and nondrug users. They had more severe presentations, with worse initial BCVA of the affected eye (P = 0.003), larger ulcer size (P = 0.023), and higher rates of individuals below the legal vision thresholds for driving (P = 0.009) and blindness (P = 0.033) at initial presentation. Opioid use was associated with increased rates of hospitalization (P < 0.001), higher fortified antibiotic use (P = 0.009), worse final BCVA of the affected eye (P = 0.020), and increased rates of BCVA worse than the legal vision thresholds for driving (P = 0.043) and blindness (P < 0.001) on final presentation.

Conclusions:

Infectious keratitis associated with opioid use is associated with more severe presentations and poorer outcomes, including higher rates of visual disability.
The CARE Health Advocacy Intervention Improves Trauma-Informed Practices at Domestic Violence Service Organizations to Address Brain Injury, Mental Health, and Substance Use
Authors: Nemeth Julianna , Ramirez Rachel , Debowski Christina , Kulow Emily , Hinton Alice , Wermert Amy , Mengo Cecilia , Malecki Alexis , Glasser Allison , Montgomery Luke , Alexander Cathy
Published: March 2023

Objective:

The aim of this study was to evaluate the impact that domestic violence (DV) service organizations' (SO) agency-wide adoption of CARE had on improving DVSO trauma-informed care (TIC) practices, overall, and in relation to addressing brain injury and mental health. CARE is an advocacy intervention designed to raise DVSOs' capacity to CONNECT with survivors; ACKNOWLEDGE that head trauma, strangulation, and mental health challenges are common; RESPOND by accommodating needs in services and providing targeted referrals; and EVALUATE effectiveness of response to meet survivors' stated concerns. We hypothesized that TIC would significantly improve among DVSO staff with the agency's use of CARE.

Setting/Participants/Design:

Pre- (n = 53) and 1-year post-CARE (n = 60) implementation online surveys were completed by staff at 5 DVSOs in Ohio from 2017 to 2019.

Main Measures:

Trauma-Informed Practice Scales (TIPS) were used to assess agency support and overall staff impression of implementing TIC; scales were modified to assess the use of TIC-practices related to head trauma, strangulation, mental health, suicide, and substance use. Attitudes Regarding Trauma-Informed Care (ARTIC-45) subscales assessed DVSO staff's endorsement of personal and organizational support in implementing TIC practices. Response options on the Survivor Defined Practice Scale (SDPS) were modified to gain staff insight into DVSO's ability to facilitate survivor empowerment. Differences in endorsement of TIC practices between pre- and post-CARE implementation were evaluated using regression models.

Results:

DVSO agency environment (P < .01) and overall staff impression (P < .001) regarding implementing TIC practices, and in respect to head trauma (P < .01), strangulation (P < .01), mental health (P < .01), suicide (P = .04), and substance use (P < .01), significantly improved with the agency's use of CARE. CARE increased DVSO staff's belief in personal and organizational support to implement TIC (P < .01 and P = .02, respectively) and in their agency's ability to foster survivor empowerment (P < .01).

Conclusion:

CARE improved TIC practices of DVSOs, overall, and to address brain injury and mental health.
The Impact of Blast Exposure—With or Without Traumatic Brain Injury—on Metabolic Abnormalities in Post-9/11 Veterans
Authors: Lendvai Dora , Whittemore Robin , Womack Julie A. , Fortier Catherine B. , Milberg William P. , Fonda Jennifer R.
Published: March 2023

Objective:

The primary aim included explorations of: (1) the associations between the history of blast exposure (BE), close blast exposure (CBE), and blast-related traumatic brain injury (bTBI) and metabolic abnormality; and (2) the potential mediating effect of comorbid psychological and somatic conditions on these associations. The secondary aim explored the association of dose-response impact of BE, CBE, and bTBI and metabolic abnormality.

Setting:

Data were collected by the Translational Research Center for TBI and Stress Disorders (TRACTS).

Participants:

Post-9/11 veterans from the TRACTS baseline sample who had conflict-zone deployment experience (N = 734).

Design:

Cross-sectional secondary data analysis. We computed relative risks (RRs) and 95% CI using modified Poisson regression. We quantified the impact of co-occurring psychological and somatic conditions on this association using mediation analyses.

Main Measures:

Exposures included BE (<100 m), CBE (<10 m), and bTBI. Metabolic abnormality outcomes included (1) overweight/obesity (defined by abnormal waist-hip ratio [WHR] and abnormal waist circumference [WC]); (2) glucose dysregulation; and (3) meeting criteria for cardiometabolic syndrome (defined by guidelines).

Results:

The sample was majority male (91%) and White (68%), with a mean age of 34.6 years (SD = 8.99). Most participants had 1 or more BE (83%); 48% experienced 1 or more CBE. Overweight/obesity was highly prevalent in the sample (51% had abnormal WHR and 60% abnormal WC). There was no significant direct or indirect association between BE, CBE, and bTBI and metabolic abnormalities (RRs: 0.70-1.51; P's > .05).

Conclusion:

Future research is needed to investigate the association of BE with metabolic abnormalities with larger, more targeted sample selection, and longer follow-up. Effective and sustainable weight management and metabolic health prevention interventions for this veteran cohort are needed.
The Combination Therapy of Glucocorticoids, Tacrolimus, and Mycophenolate Mofetil in Primary Membranous Nephropathy Coexisting with Type 2 Diabetes Mellitus: A Retrospective Study
Authors: Wang Yinhong , Cui Chenkai , Tian Xuefei , Wang Li , Ma Xiaotao , Ge Heng , Zhang Lin , Xue Xiaodong , Chen Zhihao , Huo Yujia , Wang Hao , Fu Rongguo , Jia Lining
Published: March 2023

Background:

Primary membranous nephropathy (pMN) is treated with glucocorticoids or immunosuppressive agents, depending on the disease severity. However, treating pMN with type 2 diabetes mellitus (T2DM) remains challenging.

Methods:

We retrospectively collected and analyzed the data of patients diagnosed with pMN and T2DM. The low-dose multitarget regimen consists of prednisone (10 mg/d), tacrolimus (0.05 mg/kg/d, blood concentration 5–10 ng/mL), and mycophenolate mofetil (1 g/d); The cyclophosphamide (CTX) regimen consists of prednisone (initial dose 1 mg/kg/d) and CTX (0.8–1.0 g/month, cumulative dose 6–9 g).

Results:

Sixty-seven patients were diagnosed with pMN and T2DM, and 28 were enrolled in this study, with 14 cases each in the low-dose multitarget and CTX groups. Urinary protein excretion decreased significantly in both groups after treatment, which was significantly greater in the low-dose multitarget group than that in the CTX group (2 months: −4800.48 ± 3002.65 mg/24h versus −1663.32 ± 4113.98 mg/24h,P−BH= 0.045; 12 months: −7289.25 ± 2520.92 mg/24h versus −4512.79 ± 3448.85 mg/24h,P−BH= 0.044). Serum albumin levels increased more in the low-dose multitarget group than in the CTX group, although the difference was not significant. Patients treated with glucocorticoids plus CTX had worse glycemic control in two months.

Conclusion:

The combination of glucocorticoids, tacrolimus, and mycophenolate mofetil was effective for treating pMN with T2DM and not inferior to the CTX regimen in proteinuria reduction. Further studies are needed to confirm the regimen's influence on blood glucose and long-term efficacy.
Race-Modified Equations Estimating Renal Function and the Disparity in Partial Nephrectomy Use in Black Patients
Authors: Abdallah Nour , Benidir Tarik , Hofmann Martin , Haile Eiftu , Palacios Diego Aguilar , Corrigan Dillon , Krishnamurthi Venkatesh , Haywood Samuel , Eltemamy Mohamed , Kaouk Jihad , Abouassaly Robert , Gadegbeku Crystal , Campbell Steven C. , Weight Christopher J.
Published: March 2023

Purpose:

Black patients with renal tumors are less likely to undergo partial nephrectomy (PN) despite a higher risk of chronic kidney disease (CKD). Racialized equations estimating glomerular filtration rate (eGFR) estimate a 15% to 20% higher renal function for Black patients as opposed to non-Black patients. Whether raced-modified eGFR equations affect the use of nephron-sparing surgery in Black patients has not yet been explored.

Materials and Methods:

This is a single-center, retrospective review of 6327 consecutive patients who underwent PN (n = 3533) or radical nephrectomy (RN) (n = 2794) from 2005 to 2020. Patients were asked to self-report their race preoperatively. We excluded patients with a tumor thrombus (n = 149). Data were dichotomized into Black patients (n = 654) and non-Black patients (n = 5673). Multivariable logistic regression analysis controlled for known factors associated with PN. The impact of the race-modified (2009CKD-EPI) and race-free (2021CKD-EPI-refit) equations on the distribution of patients across CKD stages was analyzed.

Results:

Among 6327 patients, 10.3% were Black patients. Black patients had higher comorbidity rates and lower preoperative eGFR than non-Black patients (P < .001). Black patients had lower overall PN rates than non-Black patients (49% vs 57%; P < .001), a finding that was most pronounced in the CKD stage 1 group (55.84% vs 67.43%; P = .0011). On multivariable logistic regression analysis, the Black race was associated with lower odds of PN (OR = 0.76 (0.61-0.96), P = .001). CKD-EPI-refit moved 27% of Black patients to a lower and more accurate CKD stage.

Conclusions:

Using a conventional race-modified equation potentially overestimated the renal function of 27% of Black patients who were restaged into worse CKD stages when using the race-free equation. While the surgical approach is multifactorial, race-modified equations may overestimate renal function in a significant portion of Black patients and explain some, but not all, of the observed lower utilization of nephron-sparing surgical approaches in Black patients.
Can high-sensitive troponin levels within the normal range predict positivity in treadmill test?
Authors: Yilmaz Mustafa , Atici Adem , Sonsöz Mehmet Rasih , Çevik Erdem , Orta Hüseyin , Demirtakan Zeynep Gizem , Barman Hasan Ali , Bulat Zubeyir , Karaayvaz Ekrem Bilal , Mercanoğlu Fehmi , Zorkun Cafer
Published: March 2023

Background

This study aimed to determine whether a high level of high-sensitivity troponin T (hsTnT) predicts a positive treadmill test in patients with suspected stable ischemic heart disease (SIHD).

Methods

In all, 366 patients with suspected SIHD were included in the study. We measured the serum hsTnT levels before the treadmill test. The treadmill test was performed according to the Bruce protocol.

Results

Of the 366 patients, 97 had positive treadmill tests. The hsTnT levels were significantly higher in the positive group than in the negative group. In the binary logistic regression analysis, hsTnT, pretest probability, metabolic equivalents (METs), target heart rate (THR) percentage, and Duke treadmill score (DTS) were independent predictors of a positive treadmill test [hsTnT odds ratio (OR): 2.178, P < 0.001; pretest probability OR: 1.036, P = 0.007; METs OR: 0.755, P = 0.008; THR OR: 0.773, P < 0.001; DTS OR: 2.661, P = 0.012]. In the receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) value of the model with the combined parameters of hsTnT, pretest probability, METs, THR, and DTS was statistically significant in predicting a positive treadmill test [combined model AUC: 0.945 (0.922–0.968), P < 0.001].

Conclusions

In sum, high pretest hsTnT levels predicted a positive treadmill test in patients with suspected SIHD. Analysis of the hsTnT levels before the treadmill test can increase the sensitivity and specificity of the treadmill test. The methods for measuring hsTnT levels are cheap and easily accessible and can be used before the treadmill test in patients with suspected SIHD.
Drug-coated balloons for the treatment of stent edge restenosis
Authors: Nagasaka Takashi , Amanai Shiro , Ishibashi Yohei , Aihara Kazufumi , Ohyama Yoshiaki , Takama Noriaki , Koitabashi Norimichi , Ishii Hideki
Published: March 2023

Background

Drug-coated balloon (DCB) is a device for treating patients with in-stent restenosis; however, there are scant data on its efficacy for stent edge restenosis (SER). This study aimed to investigate the clinical outcomes of DCB use for treating SER compared with new-generation drug-eluting stent (DES) implantation.

Method

From December 2013 to January 2019, patients who underwent DES implantation or DCB for SER were enrolled. Clinical outcomes were analyzed, and propensity score with matching was conducted. The primary outcome was target-vessel revascularization (TVR). The secondary outcomes were the incidence of all-cause mortality, major adverse cardiovascular events (MACE), and target lesion revascularization (TLR).

Result

A total of 291 patients with SER were included: 160 were treated with DCB, and 131 with new-generation DES. DCB treatment for SER treatment was associated with a lower risk of TVR than DES [hazard ratio, 0.549; 95% confidence interval (CI), 0.339–0.891] at a median follow-up of 1080 days (interquartile range; 729–1080 days). Propensity score matching (PSM) was performed to adjust for baseline clinical and lesion characteristics. After PSM, no significant difference in the risk of TVR was observed (hazard ratio, 0.965; 95% CI, 0.523–1.781). Similarly, the risk for all-cause death (hazard ratio, 0.507; 95% CI, 0.093–2.770), MACE (hazard ratio: 0.812; 95% CI, 0.451–1.462), and TLR (hazard ratio: 0.962; 95% CI, 0.505–1.833) were comparable between the two groups.

Conclusion

DCB treatment efficacy for SER was similar to that of new-generation DES after PSM. DCB is a significant alternative to obtain comparable results with new-generation DES for the treatment of SER.
The State of Health and Intentions for Action to Advance Mental Health and Well-being for the Nursing Workforce
Authors: Heath Janie , Wiggins Amanda T. , Meador Donna , Kennison Monica , Woodall Marsha , Pendleton Michelle , MacCallum Tricia , Butler Karen M.
Published: March 2023

OBJECTIVE

The aims of this study were to explore the health of nurse leaders and assess intentions to integrate workplace mental health/wellness practices.

BACKGROUND

National efforts address high rates of poor mental health and lifestyle behaviors among nurses. Few studies describe the extent to which nurse leaders in academic and clinical environments can influence a strategic mission for health/well-being among the nursing workforce.

METHODS

Two hundred seventeen email invitations were distributed to nurse leaders from 5 Kentucky nursing organizations to complete a 1-time 46-item online survey assessing individual health behaviors and intentions to build a culture of workplace health/well-being.

RESULTS

Most respondents reported positive physical health (86%), positive mental health/intentions for action to change behaviors (80%), improved self-care practices (86%), integration of self-care practices in the workplace (79%), and commitment to integrate suicide prevention training (55%).

CONCLUSIONS

Overall, nurse leaders reported positive healthy behaviors. The finding that the highest intentions were reported to integrate, sustain, and/or advance lifestyle behaviors for self-care practices as well as to integrate practices for mental health and well-being in the work environment is encouraging. Enhanced strategies and efforts are needed to prioritize workplace cultures of wellness to benefit nurses and further promote well-being among nurse leaders.
An Evaluation of a Narrative Expressive Writing Program for Nurses During the COVID-19 Pandemic
Authors: Cochran Kathryn L. , Mealer Meredith
Published: March 2023

OBJECTIVE

This study aimed to evaluate a writing program targeted to reduce stress and improve resilience in nurses during the coronavirus pandemic (COVID-19).

BACKGROUND

Occupational hazards often result in poor mental health outcomes. The pandemic highlighted this problem. Because nurses face barriers to accessing support, brief interventions are needed to process stressful events.

METHODS

Over 5 weeks, nurses across the United States detailed their COVID-19 experiences through narrative expressive writing. Trained mental health professionals provided confidential feedback.

RESULTS

One thousand one hundred three nurses enrolled in the program, with 430 continuing to the 1st session. Approximately 36% who began the program completed all 5 sessions. Feedback suggested high satisfaction with their experience in the program, but no significant changes in perceived levels of stress or resilience were observed.

CONCLUSION

Narrative expressive writing is an accessible intervention with the potential to decrease stress. This program is a flexible, personalized model that managers can offer to staff to promote healthy coping strategies.
Evaluation of a Pilot Protocol for Detecting Infant Hyperopia
Authors: Morrison Ann M. , Mutti Donald O.
Published: March 2023

SIGNIFICANCE

Highly hyperopic children are at greater risk for developing conditions such as strabismus, amblyopia, and early literacy and reading problems. High hyperopia is a common finding in infants in a pediatric medical practice, and early detection can be done effectively in that setting with tropicamide autorefraction.

PURPOSE

This study aimed to evaluate the effectiveness of a pilot screening program to detect high hyperopia in 2-month-old infants in a pediatric medical practice in Columbus, Ohio.

METHODS

Cycloplegic refractive error (1% tropicamide) was measured by retinoscopy and autorefraction with the Welch Allyn SureSight (Welch Allyn/Hillrom, Skaneateles Falls, NY) in 473 infants (55.4% female) who were undergoing their 2-month well-baby visit at their pediatrician's medical practice. Cycloplegic retinoscopy (1% cyclopentolate) was repeated at a subsequent visit in 35 infants with ≥+5.00 D hyperopia in the most hyperopic meridian during the screening.

RESULTS

Twenty-eight infants (5.9%) had high hyperopia (spherical equivalent, ≥+5.00 D), and 61 (12.9%) had high hyperopia (≥+5.00 D in at least one meridian of at least one eye) by retinoscopy with 1% tropicamide. The mean ± standard deviation spherical equivalent tropicamide cycloplegic refractive error measured with retinoscopy was +2.54 ± 1.54 D (range, −3.25 to +7.00 D) and with SureSight was +2.29 ± 1.64 D (range, −2.90 to +7.53 D). Retinoscopy done using 1% cyclopentolate was 0.44 ± 0.54 D more hyperopic in spherical equivalent than with 1% tropicamide (P < .001).

CONCLUSIONS

High hyperopia was a common finding in 2-month-old infants in a pediatric medical setting that could be detected effectively by cycloplegic autorefraction using tropicamide. Greater cooperation between pediatric primary vision and medical care could lead to effective vision screenings designed to detect high hyperopia in infants.
Case Report: Asymmetric Changes of Ophthalmic Findings in Bilateral Solar Eclipse Maculopathy
Authors: Hou Xinzhu , Zhang Xin , Zhang Zhiyong
Published: March 2023

SIGNIFICANCE

A more profound understanding of the relationship between ophthalmic findings and eye dominance is needed to guide the timely and proper treatment of binocular photic maculopathy or other macular degeneration.

PURPOSE

A patient with binocular solar maculopathy presented with asymmetric ophthalmic manifestations and changes during 14 months of observation. Early recognition of solar maculopathy can be vital for early diagnosis and better prognosis.

CASE REPORT

A 21-year-old man was reported to have blurred vision after staring directly at an annular solar eclipse several times for a few seconds on June 21, 2020. His Snellen best-corrected visual acuity declined to 20/50 in both eyes. He was right-eye dominant according to the hole-in-the-card test. The funduscopy found a yellow spot in the center of both maculae. Spectral-domain optical coherence tomography images revealed a full-thickness hyperreflectivity extending from the inner retinal layers to the retinal pigment epithelium (RPE) along with a localized disruption of the ellipsoid portion of the inner segments and RPE in both eyes. The medical history and clinical manifestations described previously supported the diagnosis of solar maculopathy. Spectral-domain optical coherence tomography images during follow-up indicated a diminishing disruption of the ellipsoid portion of the inner segments and RPE without treatment. Interestingly, the nondominant left eye made a better anatomical recovery. Finally, the Snellen best-corrected visual acuity remained 20/20 in both eyes after 14 months.

CONCLUSIONS

Binocular solar maculopathy can present asymmetrically and recover asymmetrically as well. The dominant eye suffered more obvious damage and poorer anatomical recovery than the nondominant eye.
Expression and Clinical Significance of Golgi Phosphoprotein 3 (GOLPH3) in Papillary Thyroid Carcinoma
Authors: Yu Wai-Shi , Zhou Zhi-Ping , Zeng Jian-Feng , Huang Zhen-Qiang , Qiu Cheng-Zhi
Published: March 2023

This study aimed to explore the correlation of Golgi phosphoprotein 3 (GOLPH3) levels in papillary thyroid carcinoma (PTC) and papillary thyroid microcarcinoma (PTMC) with clinicopathologic features. GOLPH3 expression was determined by western blotting in solid tumors and the adjacent normal thyroid tissues. Mammalian target of rapamycin (mTOR) and Ki-67 were examined by immunohistochemical staining. Significantly higher levels of GOLPH3 protein were observed in PTC and PTMC compared with the adjacent normal thyroid tissues (P<0.001). GOLPH3 level was positively associated with lymph node metastasis and clinical stage in PTC (P<0.05) and utterly related to the clinical stage in PTMC (P=0.012). No correlation was observed between GOLPH3 level and other clinicopathologic parameters such as sex, local invasion, tumor number, and tumor size. The expression level of GOLPH3 protein in mTOR-positive PTC was significantly higher than in mTOR-negative PTC (P=0.002 in PTC, P=0.022 in PTMC) and positively correlated with Ki-67 proliferation index in PTC via Pearson correlation analysis (r=0.353, P=0.007 in PTC; r=0.583, P<0.001 in PTMC). In conclusion, the relative expression level of GOLPH3 protein was significantly higher in PTC and PTMC than in normal thyroid tissues and increased with cancer severity. It may provide adjunctive information for diagnosing and predicting prognosis in patients with PTC or PTMC.
Role of the Microbiome in Immunotherapy of Melanoma
Authors: Jiminez Victoria , Yusuf Nabiha
Published: March 2023

Novel immunotherapeutics for advanced melanoma have drastically changed survival rates and management strategies in recent years. Immune checkpoint inhibitors have emerged as efficacious agents for some patients but have not been proven to be as beneficial in other patient cohorts. Recent investigation into this observation has implicated the gut microbiome as a potential immunomodulator in regulating patient response to therapy. Numerous studies have provided evidence for this link. Bacterial colonization patterns have been associated with therapeutic outcomes, under the notion that favorable commensal organisms improve host immune response. This review aims to report the most recent and pertinent findings related to the relationship between gut microbial communities and melanoma therapy efficacy. This article also highlights the emerging frontier of artificial intelligence in its application regarding patient microbial composition evaluation, predictive models for therapy response, and recommendations for the future of probiotics and dietary interventions to optimize melanoma survival and outcomes.
Short- and Long-term Repercussions of Vancomycin on Immune Surveillance and the Efficacy of Antitumor Treatments
Authors: Paz del Socorro Thomas , Tonneau Marion , Pasquier David , Chamaillard Mathias
Published: March 2023

Although antibiotic is a major contributor to shifts in the intestinal flora that may persist for up to several months after cessation, it is now increasingly recognized that its prescription may differentially influence clinical outcome of different anticancer treatments. Intense clinical and basic research efforts aim then at gaining sufficient insights about how the cooperative action between the intestinal ecosystem and immune surveillance modulates the efficacy of anticancer treatments. In this review, we summarize multiple levels of knowledge between vancomycin exposure, the gut microbiota, and a meaningful therapeutic response. Furthermore, we discuss the mode of action of antibiotic therapy that is prescribed for prophylaxis of bacteremia and neutropenia and outline the opportunity for judiciously improving the efficacy of anticancer drugs.