Understanding Hispanic Patient Satisfaction with Telehealth During COVID-19

BackgroundRecent studies have described the use of telehealth for pediatric surgical care during the COVID-19 pandemic. We aimed to evaluate equity in telehealth use by comparing rates of utilization and satisfaction with pediatric surgical telemedicine among Hispanic patients.MethodsWe conducted a retrospective cohort study of patients seen by a surgical subspecialty provider in the outpatient setting at a quaternary pediatric hospital between April 1 and June 30, 2020. Patients evaluated in the same three-month period in 2019 were analyzed as a historic control. Differences in Family Experience Survey (FES) responses based on race and ethnicity and preferred language of care were assessed using univariable and multivariable generalized linear modeling.ResultsThe pandemic cohort included fewer patients of Hispanic ethnicity and fewer Spanish-speakers. After controlling for visit type, comparison of Spanish-speaking and English-speaking patients revealed that Spanish-speaking families had significantly lower scores for FES items that evaluated healthcare provider explaining (IRR 0.74, 95% CI: 0.61–0.90), listening (IRR 0.76, 95% CI: 0.63–0.92), and time spent with the family (IRR 0.73, 95% CI: 0.60–0.89). There were no differences in FES responses based on insurance status or degree of medical complexity.ConclusionsTelehealth services were less commonly used among Hispanic and Spanish-speaking patients. Language may differentially affect family satisfaction with healthcare and telehealth solutions. Strategies to mitigate these inequities are needed and may include strengthening interpreter services and providing language-concordant care.Level of evidenceLevel IV.     

非小细胞肺癌组织中磷酸化4E结合蛋白1表达及其与根治术后复发的关系

目的：探讨非小细胞肺癌（NSCLC）组织中磷酸化4E结合蛋白1(p-4EBP1)表达及其与根治术后复发的关系。方法：选取本院2020年1月—2021年1月收治的111例行根治术的NSCLC患者,收集患者手术切除的肺癌组织和癌旁组织,采用免疫组化法检测肺癌组织及癌旁组织中p-4EBP1蛋白表达,比较不同临床病理特征NSCLC患者肺癌组织p-4EBP1蛋白表达情况。随访统计NSCLC患者术后1年复发情况,对比复发组（20例）和未复发组（91例）肺癌组织p-4EBP1蛋白表达,并采用多因素Cox回归模型分析NSCLC根治术后复发的影响因素。结果：肺癌组织p-4EBP1蛋白阳性表达率高于癌旁组织（70.27%vs 16.22%,P <0.05）;临床分期Ⅲa期、低分化、淋巴结转移患者肺癌组织p-4EBP1蛋白阳性表达率分别高于临床分期Ⅰ/Ⅱ期、中高分化、无淋巴结转移患者（P <0.05）;术后1年,111例患者的复发率为18.02%(20/111),复发组肺癌组织p-4EBP1蛋白阳性表达率高于未复发组（90.00%vs 65.93%,P <0.05）;复发组有吸烟史、临床分...     

小肠缺血时间与HMGB1水平的相关性研究及意义探讨

目的：探讨大鼠小肠缺血时间与大鼠高迁移率簇蛋白1（HMGB1）水平的相关性,并分析其意义。方法：选用成年雄性SD大鼠,建立小肠缺血动物模型,随机分为假手术组（n=6）、缺血15、30、45、60、75min组（各组n=12）。检测各组复灌6h时血清及小肠组织内HMGB1水平,检测小肠上皮损伤程度,记录1周存活情况。结果：大鼠缺血前有少量HMGB1表达,随着小肠缺血时间的延长,小肠组织和血清中HMGB1水平明显升高,并且与小肠损伤程度相关。缺血时间≤45min,大鼠1周存活率为100%,缺血时间达到60min时,大鼠1周存活率为67%。结论：大鼠小肠缺血再灌注损伤能致大鼠HMGB1水平显著增高,HMGB1水平与缺血时间及肠损伤程度密切相关。     

Feline mitochondrial DNA sampling for forensic analysis: When enough is enough!

Pet hair has a demonstrated value in resolving legal issues. Cat hair is chronically shed and it is difficult to leave a home with cats without some level of secondary transfer. The power of cat hair as an evidentiary resource may be underused because representative genetic databases are not available for exclusionary purposes. Mitochondrial control region databases are highly valuable for hair analyses and have been developed for the cat. In a representative worldwide data set, 83% of domestic cat mitotypes belong to one of twelve major types. Of the remaining 17%, 7.5% are unique within the published 1394 sample database. The current research evaluates the sample size necessary to establish a representative population for forensic comparison of the mitochondrial control region for the domestic cat. For most worldwide populations, randomly sampling 50 unrelated local individuals will achieve saturation at 95%. The 99% saturation is achieved by randomly sampling 60–170 cats, depending on the numbers of mitotypes available in the population at large. Likely due to the recent domestication of the cat and minimal localized population substructure, fewer cats are needed to meet mitochondria DNA control region database practical saturation than for humans or dogs. Coupled with the available worldwide feline control region database of nearly 1400 cats, minimal local sampling will be required to establish an appropriate comparative representative database and achieve significant exclusionary power.     

An improved technique for the extraction of stochastic parameters from stabilograms

An improved characterization of the dynamics of postural sway can provide a better understanding about the functional organization of the postural control system as well as a more robust tool for postural pattern recognition. To this aim, a novel parameterization was applied to the stabilogram diffusion analysis formerly proposed by Collins and De Luca [Collins JJ, De Luca CJ. Open-loop and closed-loop control of posture: a random-walk analysis of center-of-pressure trajectories. Exp Brain Res 1993;95:308–18] that considered the act of maintaining posture as a stochastic process. The main purpose of the present technique was to overcome some drawbacks of the model presented by Collins and De Luca that may restrain its potential application in clinical practice. The approach uses a unique non-linear model to describe the center of pressure (COP) dynamics that reduces the number of parameters and decreases their intra-subject variability; consequently, fewer trials are required to perform reliable estimates of stochastic parameters and this is of particular importance for subjects that cannot afford many repeated measurements because of age or pathology. Four new statistical mechanics parameters (NSMP) were computed on the log–log stabilogram diffusion plots and their estimates were compared in terms of reliability and sensitivity to the visual conditions with: (1) a minimal set of four summary statistic scores (SSS); and (2) the six statistical mechanics parameters (SMP) proposed by Collins and De Luca. All four NSMP showed at least a fair-to-good reliability (intraclass correlation coefficient, ICC>0.49) while SMP (ICC>0.20) showed some poor reliability. A better overall reliability was also observed with respect to SSS. Moreover, only NSMP had a similar score for eyes open and eyes closed conditions. Three out of four NSMP were also significantly sensitive to eyes open or closed conditions (P<0.001) while only three out of six SMP were sensitive to operating conditions (P<0.01).     

高迁移率族蛋白B1 mRNA在脓毒症大鼠脾脏中的表达

目的：探讨高迁移率族蛋白B1（HMGB1）mRNA在脓毒症大鼠外周免疫器官脾脏的表达规律及其与血清肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）的关系。方法：采用盲肠结扎穿孔（CLP）方法制备大鼠脓毒症模型。83只大鼠随机分为正常对照组（10只）、盲肠结扎穿孔组（38只）,盲肠结扎穿孔丙酮酸乙酯治疗组（35只）。分别于CLP术后4、12、24、48、72h或CLP术后丙酮酸乙酯治疗12、24、48、72h活杀动物,留取脾脏组织和血清标本,用半定量逆转录-聚合酶链式反应（RT-PCR）技术检测脾脏组织HMGB1mRNA的表达规律,用放射性免疫方法检测血清TNF-α和IL-6的浓度。结果：HMGB1mRNA在正常大鼠脾脏组织有轻度表达,CLP术后表达显著增强（P〈0.05）。CLP术后24h和72h分别出现两个高峰。丙酮酸乙酯液治疗可显著降低CLP术后大鼠脾脏组织HMGB1mRNA的表达（P〈0.05）。CLP术后大鼠血清TNF-α和IL-6浓度显著增高（P〈0.05）,丙酮酸乙酯治疗可显著降低CLP术后大鼠TNF-α和IL-6的浓度（P〈0.05）。结论：HMGB1在脓毒症大鼠外周免疫器官脾脏的表达显著增高,并与血清TNF-α和IL-6等炎症因子的增高有重要关系;HMGB1参与了失控性炎症反应的发展过程。     

血必净注射液对烫伤大鼠高迁移率族蛋白B1表达和急性肝损伤的影响

目的 了解血必净注射液对烫伤大鼠肝组织高迁移率族蛋白B1(HMGB1)表达及急性肝损伤的影响.方法 制作大鼠30%TBSA Ⅱ度烫伤模型,将78只大鼠按随机数字表法分为假伤组(18只)、烫伤组(30只)和血必净治疗组(30只),分别于伤后8、24、72 h处死取材.观察肝组织病理学变化;测定血清丙氨酸转氨酶(ALT)和天冬氨酸转氨酶(AST)水平;RT-PCR法检测肝组织HMGB1 mRNA表达,蛋白质印迹法及免疫组织化学法检测肝组织HMGB1蛋白相对表达量,结果 分别以积分吸光度比值、吸光度值表示.结果 光学显微镜下可见烫伤组大鼠肝组织有大量炎性细胞浸润,以伤后24 h较多;治疗组则明显减少.与假伤组比较,烫伤组大鼠血清ALT、AST水平显著增高(P<0.05或P<0.01),肝组织HMGB1基因和蛋白表达于伤后8～72 h显著增强(P<0.05或P<0.01).与烫伤组比较,治疗组大鼠血清ALT、AST水平有不同程度下降(P<0.05或P<0.01);伤后24、72 h肝组织HMGB1 mRNA表达分别为0.60±0.15、0.55±0.07,蛋白水平分别为163±13、160±16,显著低于烫伤组的0.75±0.12、0.78±0.11和200±13、175±14(P<0.05或P<0.01).结论 HMGB1 作为晚期炎性因子,参与了严重烫伤大鼠肝组织炎性反应的病理过程.血必净治疗可明显下调HMGB1表达,有助于减轻延迟复苏导致的急性肝损伤.