The Effect of Providing Audiovisual Surgical Information on Decisional Conflict in Patients Undergoing Plate Fixation for Distal Radius Fractures

BackgroudPatients experiencing acute trauma have limited time for their involvement in shared decision making, which may lead to decisional conflict. The purpose of this study was to evaluate whether providing audiovisual surgical information can reduce decisional conflict when deciding between surgical and nonsurgical treatment in patients with distal radius fractures (DRFs) and to evaluate factors that may affect decisional conflict.MethodsWe prospectively enrolled 50 consecutive patients who presented with acute DRFs and chose to undergo surgery, for which volar plate fixation was recommended. We randomized these patients into 2 groups. The test group was given a video clip of audiovisual surgical information in addition to regular information while the control group was only given regular information. The video clip consisted of the purpose, procedure, and effect of the surgery, precautions and complications after the operation, and other treatment options that could be performed if operation was not performed. At 2 weeks after the surgery, we evaluated patients'' decisional conflict using a decisional conflict scale (DCS). In addition, we evaluated factors that might affect decisional conflict, such as age, dominant hand, comorbidities, history of previous operations, perceived disability, and provision of the video clip.ResultsThe test group showed significantly lower DCS scores than the control group (19.6 vs. 32.1, p = 0.001). In multivariate analysis, younger age and provision of the video clip were associated with lower DCS scores.ConclusionsThis study has demonstrated that providing information through audiovisual media such as video clips could reduce decisional conflict in patients who chose to undergo plate fixation for DRFs. This study also suggests that older patients may need more careful doctor-patient communication as they have more decisional conflict than younger patients.     

Genetic alteration and immunohistochemical staining patterns of ovarian high‐grade serous adenocarcinoma with special emphasis on p53 immnnostaining pattern

We evaluated p53, KRAS, BRAF and CTNNB1 mutation and p53, WT1, p16 and beta‐catenin expression in 31 ovarian high‐grade serous adenocarcinoma. Twenty‐five (80.6%) tumors contained functional mutations of p53; three frameshift, four nonsense and 19 missense mutations. None of the tumors showed KRAS, BRAF or CTNNB1 mutation. In all 18 tumors with missense mutations, ≥60% of tumor cells were strongly positive for p53 immunostaining whereas all tumors with frameshift or nonsense mutations were completely negative. Missense mutation was correlated with diffuse and strong imunoreaction and frameshift/nonsense mutation was correlated with completely negative immunoreaction (P = 0.000). Tumors with wild‐type p53 revealed a wide range of immunostaining patterns. In 27 (87.1%) and 18 (58.1%) tumors, ≥50% of tumor cells were moderate to strongly positive for WT1 and p16, respectively. A considerable intratumoral heterogeneity for p16 expression was present. None of the tumors demonstrated nuclear beta‐catenin expression. p53 mutations appear to be a powerful molecular marker for ovarian high‐grade serous adenocarcinoma. Using p53 with an appropriate interpretation criteria together with WT1, p16 and beta‐catenin, most of the high‐grade serous adenocarcinoma could be distinguished from other ovarian tumors.     

Comparison of Therapeutic Efficacy and Clinical Parameters Between Recombinant Human Thyroid Stimulating Hormone and Thyroid Hormone Withdrawal in High-Dose Radioiodine Treatment with Differentiated Thyroid Cancer

Purpose

High-dose radioiodine treatment (HD-RIT) after injection of recombinant human thyroid stimulating hormone (rh-TSH) has become widely used. This study compared the therapeutic efficacy of HD-RIT and clinical parameters between rh-TSH supplement and thyroid hormone withdrawal (THW) after total thyroidectomy in patients with differentiated thyroid cancer.

Methods

We retrospectively reviewed 266 patients (47 male and 219 female; age, 49.0 ± 10.9 years) with differentiated thyroid cancer detected from September 2011 to September 2012. Patients comprised THW (217, 81.6 %) and rh-TSH (49, 18.4 %). Inclusion criteria were: first HD-RIT; any TN stage; absence of distant metastasis. To evaluate the complete ablation of the remnant thyroid tissue or metastasis, we reviewed stimulated serum thyroglobulin (sTg), I-123 whole-body scan (RxWBS) on T4 off-state, and thyroid ultrasonography (US) or [F-18]-fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) 6–8 months after HD-RIT. We defined a complete ablation state when all three of the follow-up conditions were satisfied; <2.0 ng/ml of the sTg, I-123 RxWBS (−), and thyroid US or F-18 FDG PET/CT (−). If one of the three was positive, ablation was considered incomplete. We also compared various clinical biomarkers (body weight, body mass index, liver and kidney function) between THW and rh-TSH groups.

Results

The rates of complete ablation were 73.7 % (160/217) for the THW group and 73.5 % (36/49) for the rh-TSH group. There was no significant difference between the two groups (p = 0.970). The follow-up aspartate transaminase (p = 0.001) and alanine transaminase (p = 0.001) were significantly higher in the THW group. The renal function parameters of blood urea nitrogen (p = 0.001) and creatinine (p = 0.005) tended to increase in the THW group. The change of body weight was + Δ0.96 (±1.9) kg for the THW group and was decreased by -Δ1.39 (±1.5) kg for the rh-TSH group. The change of body mass index was 0.4 (±0.7) kg/m² in the THW group and was decreased by −0.6 (±0.6) kg/m² in the rh-TSH group.

Conclusions

Consistent with previous studies, the rates of complete ablation between the THW and rh-TSH groups were not significantly different. The clinical parameters, as we mentioned above, were elevated for THW group but were irrelevant for the rh-TSH group. The findings favor HD-RIT after rh-TSH, especially for patients with chronic liver and kidney disease.     

Changes in serum serotonin levels in patients with acute coronary syndrome and stable angina undergoing percutaneous coronary intervention

ObjectiveActivated platelets release serotonin, causing platelet aggregation and vasoconstriction. Serotonin levels were investigated in patients with acute coronary syndrome (ACS) and chronic stable angina (CSA) treated with percutaneous coronary intervention (PCI).MethodsConsecutive patients undergoing PCI for either ACS or CSA were enrolled between July 2009 and April 2010. Patients were pre-treated with dual antiplatelet agents (aspirin and clopidogrel) before PCI. Serum serotonin levels, measured at baseline, pre- and post-PCI, and at 90 min, and 6, 12, 24 and 48 h following PCI, were compared between ACS and CSA groups.ResultsSixty-three patients with ACS and 60 with CSA were included. Overall baseline characteristics were similar between the two groups. Serotonin levels at post-PCI (55.2 ± 120.0 versus 20.1 ± 24.0) and at peak (regardless of timepoint; 94.0 ± 170.9 versus 38.8 ± 72.3) were significantly higher in the ACS versus CSA group. At 90 min and 6, 24 and 48 h post-PCI, serum serotonin was numerically, but not significantly, higher in patients with ACS. Serotonin levels fluctuated in both groups, showing an initial rise and fall, rebound at 24 h and drop at 48 h post-PCI.ConclusionsIn patients undergoing PCI, serum serotonin was more elevated in patients with ACS than those with CSA, suggesting the need for more potent and sustained platelet inhibition, particularly in patients with ACS.     

Socioeconomic inequalities and Black/White disparities in US cocaine-involved overdose mortality risk

Purpose

This study examined whether socioeconomic inequalities account for Black/White disparities in: (a) the prevalence of potential risk factors for overdose among adults using cocaine; and (b) national mortality rates for cocaine-involved overdose.

Methods

Data from 2162 Non-Hispanic (NH) Black or White adults (26 +) who reported past-year cocaine use in the 2015–2019 National Survey of Drug Use and Health were analyzed to obtain predicted probabilities of potential overdose risk factors by race and sex, using marginal effects via regression analyses, adjusting for age and socioeconomic indicators. Next, National Center for Health Statistics data (for 47,184 NH Black or White adults [26 +] who died of cocaine-involved overdose between 2015 and 2019) were used to calculate cocaine-involved overdose mortality rates by race and sex across age and educational levels.

Results

Several potential overdose vulnerabilities were disproportionately observed among NH Black adults who reported past-year cocaine use: poor/fair overall health; cocaine use disorder; more days of cocaine use yearly; hypertension (for women); and arrests (for men). Adjusting for age and socioeconomic indicators attenuated or eliminated many of these racial differences, although predicted days of cocaine use per year (for men) and cocaine use disorder (for women) remained higher in NH Black than White adults. Cocaine-involved overdose mortality rates were highest in the lowest educational strata of both races; nonetheless, Black/White disparities were observed even at the highest level of education, especially for adults ages 50 + .

Conclusion

Age and socioeconomic characteristics may account for some, yet not all, of Black/White disparities in vulnerability to cocaine-involved overdose.

     

Expression and prognostic significance of epithelial-mesenchymal transition-related markers and phenotype in serous ovarian cancer

The epithelial-mesenchymal transition (EMT) is known to be associated with carcinoma invasion and metastasis. Previous studies have demonstrated that the expression of EMT-related proteins in carcinoma cells in many organs is associated with a higher histologic grade and a poor prognosis. However, the clinical significance of EMT in ovarian cancers is controversial.Formalin-fixed and paraffin-embedded tumor samples of 198 high-grade serous carcinomas (HGSCs) and 13 serous borderline tumors or low-grade serous carcinomas (SBT/LGSCs) of the ovary were analyzed. EMT phenotype marker expression, including claudin 4, E-cadherin, N-cadherin, α-smooth muscle actin (α-SMA) and vimentin, and EMT related transition factor expression, including paired-related homeobox 1 (PRRX1), SLUG, SNAI1, and TWIST1, were evaluated by immunohistochemistry. EMT phenotype was classified into three groups including complete EMT phenotype, incomplete EMT phenotype, and epithelial phenotype according to epithelial and mesenchymal marker expression.EMT phenotypes varied in HGSC (Complete phenotype, 32.3%; Incomplete phenotype, 42.9%; epithelial phenotype, 24.7%) compared with SBT/LGSC. EMT phenotype and each EMT phenotype markers were not significantly associated with patient survival of HGSCs in multivariate analysis. However transition factor, SLUG expression, correlated with advanced disease and SLUG expression was an independent predictor of poor overall survival in HGSC.EMT related transition factor expression like SLUG is more important in association with clinical outcome than EMT phenotype itself in HGSC.     

The suppression of prion propagation using poly-L-lysine by targeting plasminogen that stimulates prion protein conversion

Poly-l-lysine (PLL), a homopolymer of amino acid l-lysine (LL), has been frequently used for drug delivery. Here, we report that PLL is an effective agent to inhibit propagation of prions that cause fatal and incurable neurologic disorders in humans and animals, termed prion diseases. In our recent investigation on prion propagation facilitated by conversion of the cellular prion protein (PrP) to the misfolded, disease-associated PrP (PrP(Sc)), we demonstrated that plasminogen stimulates PrP conversion as a cellular cofactor. In the current study, we targeted plasminogen using PLL and assessed its anti-prion efficacy. The results showed that PLL strongly inhibited PrP(Sc) propagation in the cell-free, cell culture, and mouse models of prion disease. These results confirm the role of plasminogen in PrP(Sc) propagation, validates plasminogen as a therapeutic target to combat prion disease, and suggests PLL as a potential anti-prion agent. Therefore, our study represents a proof-of-concept that targeting plasminogen, a cofactor for PrP conversion, using PLL results in suppression of prion propagation, which represents a successful translation of our understanding on details of prion propagation into a potential therapeutic strategy for prion diseases.     

Magnetic superlattices and their nanoscale phase transition effects

The systematic assembly of nanoscale constituents into highly ordered superlattices is of significant interest because of the potential of their multifunctionalities and the discovery of new collective properties. However, successful observations of such superlattice-associated nanoscale phenomena are still elusive. Here, we present magnetic superlattices of Co and Fe(3)O(4) nanoparticles with multidimensional symmetry of either AB (NaCl) or AB(2) (AlB(2)). The discovery of significant enhancement (approximately 25 times) of ferrimagnetism is further revealed by forming previously undescribed superlattices of magnetically soft-hard Fe(3)O(4)@CoFe(2)O(4) through the confined geometrical effect of thermally driven intrasuperlattice phase transition between the nanoparticulate components.     

Military service and crime: new evidence

Background

Evidence indicates that a substantial proportion of military personnel are involved in high-risk and antisocial behaviors that place them at jeopardy for criminal justice system involvement. However, prior research on military service and crime has disproportionately focused on veterans from the Vietnam War era (1955–1975), and has tended to focus on either current or former military members.

Methods

This study employed data from a population-based study (i.e., National Study on Drug Use and Health [NSDUH] between 2002 and 2014). It systematically examines the prevalence of self-reported antisocial behaviors, criminal justice system involvement, and substance abuse among the US civilian population and military service members, including reservists (n?=?2206) and those who reported having been separated or retired from military service (n?=?20,551). These factors are further examined across the developmental spectrum of adulthood (ages 18–34, 35–49, and 50–64).

Results

Results showed that military members were more prone to lifetime arrests and overall substance misuse. However, additional findings emerged suggesting that, while the military population overall seems to be positively associated with higher criminal activity than that found in the civilian population, these findings were based on a specific subgroup of the veteran population. This subgroup is comprised of individuals who likely did not fit in with the military culture and were discharged from the military early in their careers.

Conclusion

Additional research on identifying this subgroup of military members is encouraged to better concentrate on prevention and treatment measures.