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Investigating Post-Operative Refractive Outcomes in Patients Undergoing Cataract Surgery to Assess the Potential Impact of a Concurrent Diagnosis of Dry Eye Disease (DED) 调查白内障手术患者术后屈光结果,评估同时诊断出干眼症 (DED) 的潜在影响
Pub Date : 2024-01-11 DOI: 10.18060/27882
Ateik Almalahi, Barbara Schroeder
Cataract surgery is one of the most performed surgical procedures in the world. A cataract is defined as opaqueness in the interior of the ocular lens2. The exact etiology of cataracts is multifactorial ranging from environmental conditions to biochemical changes induced by aging3. The Intraocular lens (IOL) power calculation is an essential part of the pre-operative planning for cataract surgery as it determines the specific IOL that should be utilized for a patient. Keratometry measurements are required for this IOL power calculation, however, DED has been shown to cause inaccurate keratometry measurements4,5. We hypothesize that patients with DED undergoing cataract surgery will have a larger deviation from the predicted spherical equivalent (SE) post-operatively. Patients who were over the age of 18 and underwent cataract surgery were included. Patients who had a diagnosis of glaucoma, Herpes Simplex Keratitis, punctual plugs, undergone Laser-Assisted in Situ Keratomileusis (LASIK) surgery, Radial Keratometry, or any form of corneal scarring were excluded from this study as they can negatively impact keratometry measurements. The DED sample had a statistically significant larger SE deviation from the predicted SE compared to the healthy sample (p=0.037). The DED sample also had a statistically significant larger percentage of patients with an SE deviation of 0.50 D or greater (p=0.002). Finally, the DED had a statistically significant older age than the healthy group (p=0.028). The significant difference in age between the healthy sample and the DED sample confirms the significant correlation between age and prevalence of DED the literature has described6. The statistically significant increased post-operative SE deviation from predicted SE within the DED sample can be the result of the increased variability in the tear film associated with DED. This can lead to inaccurate keratometry measurements, thus leading to incorrect IOL power calculations.
白内障手术是世界上开展最多的外科手术之一。白内障的定义是眼球晶状体内部不透明2。白内障的确切病因是多因素的,包括环境条件和老化引起的生化变化3。眼内人工晶体(IOL)的功率计算是白内障手术术前规划的重要组成部分,因为它决定了患者应使用的特定人工晶体。计算 IOL 功率时需要进行角膜度数测量,但已证明 DED 会导致角膜度数测量不准确4,5。我们假设,接受白内障手术的 DED 患者术后与预测球面等效值 (SE) 的偏差会更大。我们纳入了接受白内障手术的 18 岁以上患者。被诊断为青光眼、单纯疱疹性角膜炎、点状角膜栓塞、接受过激光辅助原位角膜磨镶术(LASIK)手术、径向角膜测量法或任何形式的角膜瘢痕的患者不在研究范围内,因为它们会对角膜测量法的测量结果产生负面影响。与健康样本相比,DED 样本的 SE 与预测 SE 的偏差具有显著的统计学意义(P=0.037)。DED 样本中 SE 偏离 0.50 D 或更大的患者比例也有显著统计学意义(p=0.002)。最后,从统计学角度看,DED 患者的年龄明显大于健康组(p=0.028)。健康样本与 DED 样本在年龄上的显著差异证实了文献中描述的年龄与 DED 患病率之间的显著相关性6。在 DED 样本中,术后 SE 与预测 SE 的偏差在统计学上有明显增加,这可能是与 DED 相关的泪膜变异性增加的结果。这可能导致角膜测量不准确,从而导致 IOL 功率计算错误。
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引用次数: 0
Factors Contributing to Potentially Unnecessary Pediatric Emergency Transfers 导致潜在不必要儿科急诊转院的因素
Pub Date : 2024-01-11 DOI: 10.18060/27741
Kortni Clements, Nancy Glober
Background: Riley Hospital for Children receives thousands of emergency pediatric transfers from outside hospitals every year. The United States is currently facing a national EMS shortage along with increasing costs of medical care. Additionally, these transfers can be inconvenient for patients and their families. However, not all of these transfers are medically necessary. Identifying factors that contribute to unnecessary emergency transfers is essential for optimizing care for each patient. Methods: Retrospective chart reviews of electronic medical records at Riley Hospital for Children were completed for transferred patients between 01/01/2022 to 02/20/2022. Patients were identified through the transfer center patient list. The primary objective of the study was to identify patients transferred and discharged from the emergency department without advanced imaging or specialist consult. Demographic data including age, race, ethnicity, and sex were collected. Results: There were 404 patients included in the study. About one third of these patients were discharged from the emergency department. Of those, 38 patients (9.4%) also did not have advanced imaging or a specialist consult in the Riley Emergency Department. Age was found tobe statistically different between these patients and all other patients. The median age for patients discharged without advanced imaging or specialist consult was 2.4 years old, while the median age for all other patients was 6.5 years old. Other demographics including race, ethnicity, and sex were not significantly different. Conclusion and Potential Impact: The results suggest that younger pediatric patients may be at a greater risk for unnecessary emergency transfer. The generalizability of this study is limited in scope due to the use of only one EMR and hospital system. Finally, as this is a retrospective study, the information is limited by what was documented.
背景介绍莱利儿童医院每年都要接收数千名从外部医院转来的儿科急诊病人。美国目前正面临着全国性急救服务短缺以及医疗费用不断上涨的问题。此外,这些转院可能会给病人及其家属带来不便。然而,并非所有这些转院都是医疗必需的。找出导致不必要紧急转院的因素对于优化每位患者的护理至关重要。方法:对莱利儿童医院 2022 年 1 月 1 日至 2022 年 2 月 20 日期间转院患者的电子病历进行回顾性病历审查。患者通过转院中心患者名单确定。研究的主要目的是确定从急诊科转院并出院的患者中是否有未经高级影像学检查或专家会诊的患者。研究还收集了包括年龄、种族、民族和性别在内的人口统计学数据。研究结果共有 404 名患者参与研究。其中约三分之一的患者从急诊科出院。其中有 38 名患者(9.4%)在莱利急诊科没有进行高级成像或专家会诊。研究发现,这些患者的年龄与所有其他患者存在统计学差异。未接受高级影像学检查或专家会诊的出院患者的年龄中位数为 2.4 岁,而所有其他患者的年龄中位数为 6.5 岁。包括种族、民族和性别在内的其他人口统计学特征没有明显差异。结论和潜在影响:研究结果表明,年龄较小的儿科患者可能面临更大的不必要紧急转院风险。由于只使用了一种电子病历和医院系统,本研究的推广范围有限。最后,由于这是一项回顾性研究,所记录的信息有限。
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引用次数: 0
Electronic Health Record-based Surveillance of Hypertension Prevalence 基于电子健康记录的高血压患病率监测
Pub Date : 2024-01-11 DOI: 10.18060/27789
Justin Stiles, Brian E. Dixon
Background:Public health officials require timely, accurate data to guide decision-making. The Behavioral Risk Factor Surveillance System (BRFSS), a nationwide telephone survey of U.S. adults conducted by the CDC, serves as a primary source for chronic disease prevalence data. However, limitations like small sample sizes and publication delays exist. A promising alternative is Electronic Health Record-based (EHR) surveillance. Under the CDC-funded Multi-state Electronic Health Record-based Network for Disease Surveillance (MENDS) project, the Regenstrief Institute utilizes EHR data from the Indiana Network for Patient Care database to detect hypertension using algorithms based on a combination of blood pressure measurements, diagnostic codes, and antihypertensive prescriptions. Methods:We compared hypertension prevalence estimates between BRFSS and MENDS using 2015 data from Indiana residents. BRFSS included individuals who positively reported a diagnosis of hypertension or antihypertensive medication use. MENDS included individuals based on clinical diagnosis, abnormal blood pressure readings, and medication history. Gestational hypertension and end-stage renal disease cases were excluded. Equivalence was empirically tested using the two one-sided t-tests (TOST) statistical method. Results:TOST analysis revealed the two methods were not equivalent overall (p < 0.0001) or in any strata measured. The EHR-based model produced a lower estimate of 18.7% (95% CI ± 7.1 x 10-6, n=10,800,076), while BRFSS produced a higher estimate of 28.4% (95% CI ± 3.8, n=934). Conclusion:BRFSS might overestimate (i.e., too sensitive) hypertension prevalence due to survey methodology, while the EHR-based model might underestimate (i.e., too specific) due to its more complex hypertension-detection algorithm. Nevertheless, the EHR-based model provides a reliable and more timely method for estimating hypertension prevalence. Implications:MENDS provides estimates for other chronic disease risk measures such as diabetes, smoking, and obesity. Participating health departments receive updated data each month and can monitor trends. By providing reliable and timely data, public health officials can make well-informed decisions to serve their communities.
背景:公共卫生官员需要及时、准确的数据来指导决策。行为风险因素监测系统(BRFSS)是美国疾病预防控制中心对美国成年人进行的一项全国性电话调查,是慢性病患病率数据的主要来源。然而,该系统存在样本量小和发布延迟等局限性。一个很有前途的替代方法是基于电子健康记录(EHR)的监测。在美国疾病预防控制中心资助的基于多州电子健康记录的疾病监测网络(MENDS)项目中,Regenstrief 研究所利用印第安纳州患者护理网络数据库中的电子健康记录数据,通过基于血压测量、诊断代码和降压处方的组合算法来检测高血压。方法:我们使用印第安纳州居民 2015 年的数据,比较了 BRFSS 和 MENDS 的高血压患病率估计值。BRFSS 包括积极报告高血压诊断或使用抗高血压药物的个人。MENDS 根据临床诊断、异常血压读数和用药史纳入个人。妊娠高血压和终末期肾病病例被排除在外。使用两个单侧 t 检验(TOST)统计方法对等效性进行了经验性检验。结果:TOST 分析表明,两种方法在总体上(P < 0.0001)或任何测量的分层中都不等同。基于电子病历的模型得出的估计值较低,为 18.7%(95% CI ± 7.1 x 10-6,n=10,800,076),而 BRFSS 得出的估计值较高,为 28.4%(95% CI ± 3.8,n=934)。结论:由于调查方法的原因,BRFSS 可能会高估(即过于敏感)高血压患病率,而基于电子健康记录的模型由于其高血压检测算法更为复杂,可能会低估(即过于特异)高血压患病率。不过,基于电子病历的模型为估算高血压患病率提供了一种可靠且更及时的方法。意义:MENDS 提供了对糖尿病、吸烟和肥胖等其他慢性病风险指标的估计。参与的卫生部门每月都会收到更新的数据,并可对趋势进行监测。通过提供可靠、及时的数据,公共卫生官员可以做出明智的决策,为社区提供服务。
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引用次数: 0
Characterization of the Function of Carbonic Anhydrase 8 碳酸酐酶 8 的功能特征
Pub Date : 2024-01-11 DOI: 10.18060/27739
Jenny Chen, Laura Smith, Benjamin Gaston
Background/Objective: Severe asthma is a complex pulmonary disease characterized by airway inflammation, bronchoconstriction, and acid-base dysregulation. In the Severe Asthma Research Program bronchoscopies, transcriptomics showed CA8 as a gene that is strongly associated with asthma severity. CA8, however, lacks classical CA enzyme function: it does not catalyze hydration and dehydration of CO2. The function of CA8 in the airway epithelium remains unknown. We hypothesize that CA8 serves a protective role in the airway due to its down regulation in patients with severe asthma. We aim to characterize the function of CA8 bystudying its potential as an enzymatic protein.Methods: We used colorimetric assays to detect and quantify nitrogen oxides. We tested for Snitrosothiolsynthase, denitrosylase, nitrate and nitrite synthase, and nitrite reductase activitiesusing the Griess reagent in conjunction with Saville denitrosylation reagents and with reduction using vanadium chloride. Samples were incubated for 60 minutes. We then went on to design ametabolomic experiment in which products will be identified by NMR: for these, we transfected Chinese hamster ovary (CHO) cells using lentivirus containing GFP-labeled CA8 or emptyvector (negative control).Results: CA8 protein does not have these following enzymatic functions: SNO synthase,denitrosylase, nitrite and nitrate synthase, and nitrite reductase. We successfully transfected with GFP-labeled CA8 and are awaiting results of the metabolomic studies.Conclusion and Potential Impact: Isolated CA8 does not appear to have any nitrogen oxideredox activities relevant to asthma. The next steps include confirmatory western and SNOwestern blots to determine protein s-nitrosylation using transfected CHO whole cell lysate. Extracellular medium pH will also be measured. We will then move on to NMR-basedmetabolomics. This will help us better understand the biochemical mechanisms of CA8.Ultimately, this can provide researchers with a novel approach to asthma treatments.
背景/目的:重症哮喘是一种复杂的肺部疾病,以气道炎症、支气管收缩和酸碱失调为特征。在重症哮喘研究项目支气管镜检查中,转录组学显示 CA8 是与哮喘严重程度密切相关的基因。然而,CA8 缺乏经典 CA 酶的功能:它不能催化二氧化碳的水合和脱水。CA8 在气道上皮细胞中的功能仍然未知。我们推测,CA8 在气道中起到保护作用,因为在严重哮喘患者中,CA8 的功能被下调。我们的目的是通过研究 CA8 作为酶蛋白的潜力来确定其功能:我们使用比色法检测和量化氮氧化物。我们使用格里斯试剂结合萨维尔变性试剂以及氯化钒还原法检测了亚硝基硫醇合成酶、变性亚硝基酶、硝酸盐和亚硝酸盐合成酶以及亚硝酸盐还原酶的活性。样品培养 60 分钟。然后,我们继续设计代谢组学实验,其中的产物将通过核磁共振来鉴定:为此,我们使用含有标记 GFP 的 CA8 或空载体(阴性对照)的慢病毒转染中国仓鼠卵巢(CHO)细胞:结果:CA8 蛋白不具有以下酶功能:结果:CA8 蛋白不具有以下酶功能:SNO 合成酶、反硝化酶、亚硝酸盐和硝酸盐合成酶以及亚硝酸盐还原酶。我们成功转染了标记 GFP 的 CA8,目前正在等待代谢组学研究的结果:分离的CA8似乎不具有任何与哮喘有关的氮氧化物氧化活性。接下来的步骤包括使用转染的 CHO 全细胞裂解液进行 Western 和 SNOwestern 印迹确认,以确定蛋白质的 s-亚硝基化。还将测量细胞外培养基的 pH 值。然后,我们将进行基于核磁共振的代谢组学研究。这将帮助我们更好地了解 CA8 的生化机制。最终,这将为研究人员提供一种治疗哮喘的新方法。
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引用次数: 0
A Review of SNAP Nutritional Incentive Programs SNAP 营养奖励计划回顾
Pub Date : 2024-01-11 DOI: 10.18060/27786
Dylan Sogocio, Antonia Sawyer, Dennis Savaiano
There are over 40 million Americans in the Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamps Program. Despite this program attempting to eliminate food insecurity for people 130% below the poverty line, it does little to prevent nutrition related health disparities between SNAP participants and people who are more financially stable. Nearly every state has nutrition incentive programs attempting to address these nutritional health disparities that SNAP does not address. To synthesize a literature review of several of these programs, a search was conducted in PubMed, PubAg, and Google Scholar databases using terms such as “SNAP” and “nutritional incentive program,” along with date restrictions for 2013 or later. This search resulted in a total of 54 articles, however only 35 were used following screening. Included articles were screened first by abstract and then article content to determine relevancy. The literature suggests that programs address nutritional health disparities by providing financial interventions for SNAP participants to make nutritionally conscious decisions about the food they purchase and consume. There were three categories of interventions that were suggested by the literature: incentives, discounts, and restrictions. Regardless of the intervention, each of these categories of intervention were praised by SNAP participants. Participants were able to purchase and consume more fruits and vegetables, focus on nutrition, and financially support local farmers markets and supermarkets. This review discusses these different interventions to allow for new or existing programs to be developed to best address nutritional health disparities using scholarly evidence.
有 4000 多万美国人参加了 "补充营养援助计划"(SNAP),该计划的前身是 "食品券计划"。尽管该计划试图消除贫困线以下 130% 人口的粮食不安全问题,但它在防止 SNAP 参与者与经济状况更稳定的人之间出现营养相关的健康差距方面却收效甚微。几乎每个州都有营养激励计划,试图解决 SNAP 无法解决的营养健康差异问题。为了对其中几项计划进行文献综述,我们在 PubMed、PubAg 和 Google Scholar 数据库中使用 "SNAP "和 "营养激励计划 "等术语进行了搜索,并将日期限制在 2013 年或之后。此次搜索共收到 54 篇文章,但经过筛选后仅采用了其中的 35 篇。纳入的文章首先根据摘要进行筛选,然后根据文章内容确定相关性。文献表明,这些计划通过为 SNAP 参与者提供财务干预措施,让他们在购买和消费食品时做出有营养意识的决定,从而解决营养健康方面的差异。文献中提出了三类干预措施:奖励、折扣和限制。无论采取哪种干预措施,每一类干预措施都受到了 SNAP 参与者的好评。参与者能够购买和消费更多的水果和蔬菜,注重营养,并在经济上支持当地的农贸市场和超市。本综述讨论了这些不同的干预措施,以便利用学术证据制定新的或现有的计划,最好地解决营养健康差异问题。
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引用次数: 0
Development of a Community Informed Approach for Implementing Support Network Trainings for Children with Autism Spectrum Disorder in Western Kenya 为肯尼亚西部自闭症谱系障碍儿童开展支持网络培训开发社区知情方法
Pub Date : 2024-01-11 DOI: 10.18060/27840
Geneva Baumberger, Saina Chelagat, Rebecca McNally Keehn, Anita Rutto, Megan S. McHenry, Mandy Rispoli
Background:Autism spectrum disorder (ASD) impacts a large global community, with a prevalence of nearly 1 in 100 children. However, little is known about the educational experience of children with ASD and other neurodevelopmental disorders (NDD) in low- and middle-income countries (LMICs). Guidance from local communities is essential when developing a cultural inquiry into this educational landscape. Our project objective was to evaluate community perspectives on ASD and areas of development for future support network trainings. Methods:This qualitative study was performed within the Academic Model Providing Access to Healthcare (AMPATH) program in Eldoret, Kenya. Using group discussions, this approach engaged stakeholders from three areas: medical personnel, educators, and caregivers/families. Kenyan professionals in child psychiatry, occupational therapy, and special education guided discussion and led the recruitment of key informants for interviews. Within this qualitative analysis, brief thematic analysis of dialogue elucidated key themes. Results:Four focus groups were held, with 87 total participants (group size = 12-29). Four main themes were identified in the data: beliefs about causes, treatment options, barriers to education, and a need for community advocacy. Advocacy was a major focus of discussions, due to a sentiment of fragmentation and poor acceptance from the community. Stigmatization carried over into localbeliefs about causes of ASD, which included poor nutrition, witchcraft, and genetics. Finding resources to access education and therapy was a challenge, especially for families in rural settings. These viewpoints informed study protocol adaptation by expanding recruitment to include community-based service providers and staff from additional schools, and integrating themes into interview questions. Conclusion:This project prioritized dialogue with stakeholders to gain insights to inform the development of a cultural inquiry into the special education landscape in western Kenya. Themes elucidated from this project provided critical feedback to inform future study protocol and an expanded recruitment plan.
背景:自闭症谱系障碍(ASD)影响着一个庞大的全球社区,发病率接近每 100 名儿童中就有 1 名。然而,人们对中低收入国家(LMICs)患有自闭症谱系障碍和其他神经发育障碍(NDD)的儿童的教育经历知之甚少。在对这种教育状况进行文化调查时,来自当地社区的指导至关重要。我们的项目目标是评估社区对 ASD 的看法以及未来支持网络培训的发展领域。方法:这项定性研究是在肯尼亚埃尔多雷特的学术模式提供医疗保健(AMPATH)项目中进行的。该方法采用小组讨论的形式,让来自三个领域的利益相关者参与其中:医务人员、教育工作者和照顾者/家庭。肯尼亚儿童精神病学、职业疗法和特殊教育方面的专业人士指导了讨论,并牵头招募了主要信息提供者进行访谈。在定性分析的基础上,对对话进行了简短的主题分析,以阐明关键主题。结果:共举行了四次焦点小组讨论,共有 87 人参加(小组人数=12-29 人)。数据中确定了四大主题:对病因的看法、治疗方案、教育障碍和社区宣传需求。宣传是讨论的一个主要焦点,因为人们有一种支离破碎和不被社区接受的感觉。当地人对自闭症病因的看法也带有污名化色彩,包括营养不良、巫术和遗传。寻找教育和治疗资源是一项挑战,尤其是对农村家庭而言。这些观点为研究方案的调整提供了依据,即扩大招募范围,纳入社区服务机构和其他学校的教职员工,并将主题纳入访谈问题中。结论:本项目优先考虑与利益相关者进行对话,以获得对肯尼亚西部特殊教育景观的文化探究发展的启示。本项目所阐明的主题为未来的研究方案和扩大招聘计划提供了重要的反馈信息。
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引用次数: 0
Kidney Disease Awareness and Knowledge Among Families and Pediatric Survivors of Severe Acute Kidney In 严重急性肾衰竭家属和儿科幸存者对肾病的认识和了解
Pub Date : 2024-01-11 DOI: 10.18060/27873
Julia Vanderkolk, Michelle C Starr
Background: Acute kidney injury (AKI) is common in pediatric patients and is associated with poor outcomes including increased risk of chronic kidney disease. It is unknown whether pediatric AKI survivors and their families are aware of their AKI diagnosis and understand the associated risks. We are seeking to identify awareness and disease-specific knowledge among pediatric AKI survivors and their families. Objectives: We hypothesize that pediatric AKI survivors and their families have a low awareness of their diagnosis and want more information about kidney health. Design/Methods: We performed a cross-sectional survey of AKI awareness and knowledge in pediatric patients with KDIGO Stage II or III AKI and their families near the time of discharge from Riley Hospital for Children. Families answered questions on AKI diagnosis awareness and AKI knowledge using the Kidney Knowledge Survey (KiKS). Results: Of 16 families included in this analysis, 75% were unaware they had experienced AKI and 94% were unaware they had a ‘problem with their kidneys’. Overall, the median AKI objective knowledge score was 60% (IQR: 31%, 69%). There was no difference in knowledge score between those that recognized their episode of AKI and those that did not. In total, 69% of families correctly defined AKI as when ‘your kidneys suddenly stop working well’. Most families recognized dehydration (56%) and infection (81%) as risk factors for AKI, however fewer recognized other risk factors such as ibuprofen use (31%). Only 38% of families reported that someone had discussed AKI during their admission, and 88% stated they wanted to learn more about AKI. Conclusion: Most families of pediatric survivors of severe AKI were unaware that their child had AKI or problems with their kidneys. Many lacked understanding of AKI risk factors and knowledge of kidney health and desired more information.
背景:急性肾损伤(AKI)在儿科患者中很常见,与不良预后有关,包括增加患慢性肾病的风险。小儿急性肾损伤(AKI)幸存者及其家属是否知道他们的 AKI 诊断并了解相关风险尚不清楚。我们正在寻求确定儿科 AKI 幸存者及其家属对 AKI 的认识和疾病相关知识。目标:我们假设小儿 AKI 幸存者及其家人对其诊断的认知度较低,并希望获得更多有关肾脏健康的信息。设计/方法:我们对 KDIGO II 期或 III 期 AKI 儿科患者及其家属在临近从莱利儿童医院出院时对 AKI 的认识和知识进行了横断面调查。患者家属使用肾脏知识调查 (KiKS) 回答了有关 AKI 诊断意识和 AKI 知识的问题。结果:在纳入本次分析的 16 个家庭中,75% 的家庭不知道他们曾经历过 AKI,94% 的家庭不知道他们的 "肾脏有问题"。总体而言,AKI 客观知识得分的中位数为 60%(IQR:31%,69%)。认识到自己发生过 AKI 的家庭和没有认识到的家庭在知识得分上没有差异。总共有 69% 的家庭正确地将 AKI 定义为 "肾脏突然停止正常工作"。大多数家庭认识到脱水(56%)和感染(81%)是导致心肌缺血的危险因素,但认识到使用布洛芬等其他危险因素的家庭较少(31%)。只有 38% 的家属表示在他们入院时有人讨论过 AKI,88% 的家属表示他们希望了解更多有关 AKI 的信息。结论大多数严重 AKI 儿科幸存者的家属都不知道他们的孩子患有 AKI 或肾脏有问题。许多人对 AKI 风险因素和肾脏健康知识缺乏了解,希望获得更多信息。
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引用次数: 0
Familial Adenomatous Polyposis within the Pediatric Hereditary Polyposis Registry 小儿遗传性息肉病登记处的家族性腺瘤性息肉病
Pub Date : 2024-01-11 DOI: 10.18060/27959
Brendan Anderson, Tina Zhang
Background/Objective:  Familial Adenomatous Polyposis (FAP) is a condition characterized by values exceeding hundreds of colorectal adenomatous polyps. FAP has a prevalence of 1 in 8,300 people, demonstrating an autosomal dominant inheritance pattern. This condition follows a pathogenic variation of the Adenomatous Polyposis Coli (APC) gene, located on chromosome 5q21-22. These mutations are heavily correlated with the incidence of colorectal carcinoma, requiring prophylactic colectomy. The management and treatment of FAP requires routine surveillance to reduce gastrointestinal polyp burden. The objective for this study is to characterize the current patient population at Riley with polyposis syndromes and assess clinical surveillance in patients diagnosed with FAP.  Methods:  Historical data from 2020-2022 GI clinical visits were reviewed using the diagnostic codes Family history of colonic polyps, Benign neoplasm of colon unspecified, and Other phakomatoses not elsewhere classified. These criteria identified 93 patients of which 64 patients were diagnosed with a hereditary polyposis syndrome for inclusion within the registry. Of the 64 patients, 42 had a diagnosis of FAP. Clinical data reviewed included the patient’s age of diagnosis, completion of genetic testing and follow-up, surgical treatment, routine endoscopic surveillance, and modes of imaging.  Results:  Results indicated a median age of diagnosis of 10 years, lower than previously reported national averages of 13.5-17 years. Evaluation of routine follow-up indicated a rate of endoscopy at 0.822 scopes per year and demonstrated that abdominal CT scans as well as abdominal X-rays were the most common supplemental modes of imaging.  Conclusion/ Future Directions:  The data from this registry will help direct care of patients with FAP, ensuring they receive treatment in accordance with national guidelines for routine surveillance and prophylactic colectomy. Moving forward, the intention is to expand the registry's date range to incorporate more patients and elaborate further on endoscopic findings for the specific subtypes of FAP.
背景/目的: 家族性腺瘤性息肉病(FAP)是一种以数值超过数百的结直肠腺瘤性息肉为特征的疾病。家族性腺瘤性息肉病的发病率为 1/8,300,呈常染色体显性遗传模式。这种疾病是由位于染色体 5q21-22 上的腺瘤性息肉病大肠(APC)基因的致病变异引起的。这些变异与结直肠癌的发病率密切相关,需要进行预防性结肠切除术。FAP 的管理和治疗需要常规监测,以减少胃肠道息肉的负担。本研究的目的是了解目前莱利息肉病综合征患者的特征,并评估对确诊为 FAP 患者的临床监测情况。 方法:使用诊断代码 "结肠息肉家族史"、"未说明的结肠良性肿瘤 "和 "未在别处分类的其他噬瘤病 "对 2020-2022 年消化道临床就诊的历史数据进行审查。根据这些标准确定了 93 名患者,其中 64 名患者被诊断为遗传性息肉病综合征,并被纳入登记册。在这 64 名患者中,42 人被诊断为 FAP。审查的临床数据包括患者的诊断年龄、基因检测和随访的完成情况、手术治疗、常规内窥镜监测以及成像方式。 结果显示 结果显示,诊断年龄的中位数为 10 岁,低于之前报告的 13.5-17 岁的全国平均水平。对常规随访的评估表明,内镜检查率为每年 0.822 例,并显示腹部 CT 扫描和腹部 X 光检查是最常见的辅助成像方式。 结论/未来方向: 该登记处的数据将有助于指导对 FAP 患者的治疗,确保他们按照常规监测和预防性结肠切除术的国家指南接受治疗。今后,我们打算扩大登记的日期范围,纳入更多的患者,并进一步阐述FAP特定亚型的内镜检查结果。
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引用次数: 0
Exploring Differentiation and TEAD Inhibition in NF2-Knockdown NES Cells 探索抑制 NF2 的 NES 细胞的分化和 TEAD 抑制作用
Pub Date : 2024-01-11 DOI: 10.18060/27844
Sidrah Badar, Noah Burket, Jignesh Tailor
Background: The NF2 gene is a tumor suppressor encoding gene on chromosome 22 that is a known regulator of the Hippo pathway. When the mammalian version of the pathway is inactive, such as with a loss of NF2, downstream proteins YAP/TAZ remain unphosphorylated, enter the nucleus to form a complex with TEAD 1/2/3/4, and begin transcription. Hyperactivation of theYAP/TAZ-TEAD complex has been observed in many cancers, allowing for targeting with TEAD inhibitors. Here, we assess how the loss of NF2 in human neuroepithelial stem (NES) cells affect their differentiational development. We also seek to understand the effects of TEAD inhibition on wildtype (WT) and NF2-knockdown NES cells. Materials and Methods: Differentiation. WT and NF2-knockdown cells were grown in media without growth factors to differentiate them. TEAD Inhibition. Non-differentiating and differentiating WT and NF2-knockdown cells were treated with TEAD Inhibitor 690 (TEADi). During both conditions, cells were harvested at 5 points throughout the growth period. Results: Decreased NF2 in cells promoted retention of an earlier cell morphology compared to WT, which appeared to develop neuronal features, such as axons. WT cells exhibited elevated expression of genes characteristic of NES differentiation when compared to NF2-knockdown cells. Following the addition of TEADi, cell culture imaging revealed seemingly increased cell death in WT cell populations compared to NF2-knockdown cells. Interestingly, differentiating NF2-knockdown cells adhere to one another to form clusters, but with TEADi, these clusters are formed to a much lesser extent. Conclusion: Although more experimentation is needed, these are early steps in demonstrating how NF2 loss appears to halt the differentiation of NES cells. Additionally, TEAD inhibition seems to reduce the clustering seen in differentiating NF2-knockdown cells; however, experimental concentrations need to be explored in the future. Further work is needed to understand the effects of TEAD inhibition on NF2-knockdown cells.
背景:NF2 基因是 22 号染色体上的肿瘤抑制基因,是已知的 Hippo 通路调节因子。当哺乳动物版本的 Hippo 通路失去活性(如 NF2 基因缺失)时,下游蛋白 YAP/TAZ 保持未磷酸化状态,进入细胞核与 TEAD 1/2/3/4形成复合物,并开始转录。在许多癌症中都观察到了YAP/TAZ-TEAD复合物的过度活化,这使得TEAD抑制剂成为靶向药物成为可能。在这里,我们评估了人类神经上皮干细胞(NES)中 NF2 的缺失如何影响其分化发育。我们还试图了解TEAD抑制剂对野生型(WT)和NF2-敲除型NES细胞的影响。材料与方法:分化。在不含生长因子的培养基中培养 WT 和 NF2-敲除细胞,使其分化。抑制 TEAD。用 TEAD 抑制剂 690(TEADi)处理未分化和分化的 WT 细胞和 NF2-敲除细胞。在这两种条件下,在整个生长期的 5 个点收获细胞。结果与 WT 细胞相比,细胞中 NF2 的减少促进了细胞形态的早期保留,WT 细胞似乎具有神经元特征,如轴突。与NF2-敲除细胞相比,WT细胞表现出NES分化特征基因的高表达。添加 TEADi 后,细胞培养成像显示,与 NF2-敲除细胞相比,WT 细胞群的细胞死亡似乎增加了。有趣的是,分化的 NF2-敲除细胞会相互粘附形成细胞簇,但加入 TEADi 后,这些细胞簇的形成程度会大大降低。结论:虽然还需要更多的实验,但这些都是证明 NF2 缺失如何阻止 NES 细胞分化的早期步骤。此外,TEAD抑制似乎减少了NF2-敲除细胞分化过程中出现的集群现象;但是,实验浓度还需要在未来进行探索。要了解TEAD抑制对NF2-敲除细胞的影响,还需要进一步的工作。
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引用次数: 0
Social Determinants of Health and 30-Day Readmissions in an Urban Community Hospital in Northwest Indiana 印第安纳州西北部一家城市社区医院的健康社会决定因素和 30 天再入院率
Pub Date : 2024-01-11 DOI: 10.18060/27898
Eric Gonsiorowski, Michael Yallourakis, Jonathan Guerrero, Baraka Muvuka
Background: Hospital readmission within 30 days of discharge is a quality of care indicator with implications for healthcare systems, payers, and patients. The Hospital Readmission Reduction Program enacted in 2012 aimed to reduce preventable readmissions. Yet in 2018, there were 3.8 million adult 30-day readmissions with an average rate of 14% and estimated cost of $15,200 per readmission. This study examined the influence of social determinants of health (SDOH), demographics, and health behaviors on 30-day readmissions at an urban hospital in Northwest Indiana. This is part of a Community-Based Participatory Research (CBPR) partnership between Indiana University School of Medicine-Northwest and St. Mary Medical Center (SMMC) to address SDOH. Methods: This retrospective study analyzed a limited dataset generated by SMMC in EPIC™ with SDOH, demographics, health behaviors, and health outcomes measures from inpatient admissions between January 2021 to March 2023. Data analysis consisted of descriptive, bivariate (Chi-Square; p<0.05), and multivariate (binary logistic regression; p<0.05) analyses in SPSS 29.0. This study was exempted by the Indiana University Human Research Protection Program (IRB #14040). Results: The sample consisted of 7445 patients, majority 65 years and above (56.5%), white (77.47%), and publicly insured (76.83%). 30-day readmissions represented 10.5% of admissions. The bivariate analysis revealed statistically significant associations between 30-dayreadmissions and age (p<0.001), language (p=0.008), insurance type (p<0.001), veteran status (p=0.017), and smoking (p<0.001). The multivariate analysis found that age (OR=1.008; p=0.004), being a non-English speaker (OR=1.866; p=0.009), public insurance (OR=2.096; p<0.001), and former smoking (OR=1.243; p=0.011) remained significantly associated with 30-day readmission. Conclusions: Social and behavioral factors were associated with 30-day readmissions in an urban community hospital. Incorporating SDOH and behavioral interventions into hospital readmission reduction programs may reinforce these programs. The upcoming CBPR phase will conduct advanced analysis on these findings to uncover new relationships relevant to SMMC’s objectives.
背景:出院后 30 天内再入院是一项医疗质量指标,对医疗系统、支付方和患者都有影响。2012 年颁布的 "减少再入院计划 "旨在减少可预防的再入院。然而,2018 年有 380 万成人 30 天再入院,平均再入院率为 14%,每次再入院的估计成本为 1.52 万美元。本研究考察了印第安纳州西北部一家城市医院的健康社会决定因素(SDOH)、人口统计学和健康行为对 30 天再入院的影响。这是印第安纳大学西北医学院与圣玛丽医疗中心(SMMC)合作开展的社区参与式研究(CBPR)的一部分,旨在解决 SDOH 问题。研究方法:这项回顾性研究分析了圣玛丽医疗中心在 EPIC™ 中生成的有限数据集,其中包括 2021 年 1 月至 2023 年 3 月期间住院病人的 SDOH、人口统计学、健康行为和健康结果指标。数据分析包括在 SPSS 29.0 中进行描述性、双变量(Chi-Square;P<0.05)和多变量(二元逻辑回归;P<0.05)分析。本研究获得了印第安纳大学人类研究保护计划(IRB #14040)的豁免。研究结果样本包括 7445 名患者,其中大多数为 65 岁及以上(56.5%)、白人(77.47%)和有公共保险(76.83%)的人。30 天再入院占入院人数的 10.5%。双变量分析显示,30 天再入院与年龄(p<0.001)、语言(p=0.008)、保险类型(p<0.001)、退伍军人身份(p=0.017)和吸烟(p<0.001)之间存在统计学意义上的显著关联。多变量分析发现,年龄(OR=1.008;p=0.004)、非英语使用者(OR=1.866;p=0.009)、公共保险(OR=2.096;p<0.001)和曾经吸烟(OR=1.243;p=0.011)仍与 30 天再入院显著相关。结论社会和行为因素与城市社区医院的 30 天再入院率有关。将 SDOH 和行为干预纳入减少再入院计划可能会加强这些计划。即将开始的 CBPR 阶段将对这些发现进行高级分析,以发现与 SMMC 目标相关的新关系。
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引用次数: 0
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Proceedings of IMPRS
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