ChemInform Research Articles

Use of Indocyanine Green Fluorescence Angiography to Assess Bowel Anastomosis in Ovarian Cancer Surgery.

The aim of this study was to investigate the efficacy of indocyanine green (ICG) fluorescence angiography in preventing anastomotic leaks and reducing the need for ostomies during cytoreductive surgery in ovarian cancer. This was a retrospective study of patients with 2014 International Federation of Obstetrics and Gynecology stage IIB-IVB ovarian cancer requiring a bowel resection during primary or secondary cytoreductive surgery at our institution between July 2021 to April 2023. Rates of ostomy performance and anastomotic leak were assessed in the ICG angiography group and the non-ICG angiography group. Frequency distributions between categorical variables were compared using Fisher's exact or Chi-squared test. Wilcoxon rank-sum test and t-test were used to compare continuous variables. During the study period, we reviewed the data of 59 consecutive patients with ovarian cancer with bowel resection; in 30 (50.85%) patients, bowel anastomosis was assessed using ICG angiography and in 29 (49.15%) patients, bowel anastomosis was not assessed using ICG angiography. Anastomotic leak rate was found to be 6.9% (n=2) in the non-ICG angiography group, and 3.33% in the ICG angiography group (n=1) (p=0.612). More diverting ostomies were performed in the non-ICG angiography group (n=6, 20.69%) compared to the ICG angiography group in which no ostomies were performed (p=0.011). ICG angiography is not associated with a decrease in anastomotic leak rates, but it may avoid ostomy formation.

Neoadjuvant Chemoradiotherapy Using Moderately Hypofractionated Intensity-Modulated Radiotherapy Versus Upfront Surgery for Resectable Pancreatic Cancer: A Retrospective Cohort Study.

The efficacy of neoadjuvant chemoradiotherapy for resectable pancreatic ductal adenocarcinoma (R-PDAC) remains unclear. This study was designed to evaluate neoadjuvant chemoradiotherapy by using intensity-modulated radiotherapy (NAC-IMRT) for R-PDAC compared with upfront surgery (UpS). Among 198 patients with R-PDAC who were indicated for resection between 2013 and 2021, 130 were included in this study after excluding patients who underwent neoadjuvant chemotherapy and did not meet the NAC-IMRT criteria (Eligible set). NAC-IMRT was planned for 58 patients, and UpS was planned for 72 patients. Additionally, in 105 patients who could undergo the planned treatment (As-treated set), the surgical, pathological, and oncological outcomes were evaluated. In the Eligible set, median overall survival (OS) was 50.5 months with NAC-IMRT and 34.7 months with UpS and progression-free survival was 20.4 months with NAC-IMRT and 13.9 months with UpS. In the As-treated set, OS was longer in the NAC-IMRT group (66.7 months vs. 34.7 months, p = 0.007). On multivariate analysis, NAC-IMRT was identified as an independent factor for better OS (hazard ratio 0.617, 95% confidence interval 0.382-0.995, p = 0.047, in the Eligible set). The incidence of postoperative complications did not show a difference between the two groups, and NAC-IMRT suppressed local tumor invasion, including lymphatic, venous, perineural invasion, and lymph node metastases. NAC-IMRT may offer superior survival outcomes and manageable toxicity in R-PDAC patients compared with upfront surgery. This study supports the efficacy and safety of NAC-IMRT and recommends its consideration in R-PDAC treatment protocols.

Nodular-bronchiectatic pattern in pulmonary nocardiosis: Immune status and treatment outcomes in a multicenter retrospective study.

Pulmonary nocardiosis is a rare opportunistic infection, with approximately 15% of patients being immunocompetent. The isolation rate of Nocardia spp. has recently increased, indicating rising clinical concern. This study aimed to summarize computed tomography (CT) findings, evaluate treatment outcomes, and improve disease recognition. We retrospectively analyzed 12 pulmonary nocardiosis cases recorded over 10 years in three hospitals, excluding two unclear cases. All pathogens were detected on smears and isolated from respiratory specimens. The mean age was 73.0±12.9 years, with 9 men and 6 smokers. Among the included patients, 8 had underlying pulmonary diseases, 4 had non-pulmonary diseases, and 3 were on steroids. The most common species were N. cyriacigeorgica and N. nova. CT findings included cavitary, consolidation/infiltrative, and nodular-bronchiectatic (NB) patterns. The NB pattern, particularly common in immunocompetent patients, was associated with significantly better treatment outcomes than non-NB patterns (Fisher's exact test, p=0.0476). All isolates were susceptible to trimethoprim/sulfamethoxazole. Eight patients recovered with appropriate antimicrobial therapy, while two patients died. Pulmonary nocardiosis presented three CT patterns, with the NB pattern being the most frequent and showing favorable treatment outcomes, especially in immunocompetent patients. While Nocardia spp. can develop in patients with preexisting bronchiectasis, it may also independently cause bronchiectasis. Nocardia infection should be considered as a differential diagnosis in patients exhibiting the NB pattern, resembling that of nontuberculous mycobacterial pulmonary diseases.

Self-directed violence and unclear intent presentation within a major trauma system. A multisite analysis.

Determining trauma as an act of Self-directed violence (SDV) or from high risk or unclear behaviours is challenging for trauma clinicians and may be affected by patient sex and mechanism of injury. The aim of this study was to examine the differences in characteristics and outcomes between those who have intentionally directed violence towards themselves with those of unclear intent, within a regional trauma system. Data was collected between January 2018 and December 2021 in patients who had been identified as a result of either self-directed violence (SDV) defined as any intentional act that can cause injury to one's self, including death or participated in high-risk behaviours, where the intent was unclear (UI). Differences between female and male patients presenting with SDV and unclear intent were explored. Overall, 2760 patients were identified, with a median age of 39 years (IQR 28-54) and just over a quarter of females (28 %). Falls from height were the most common mechanism of injury in all groups. SDV was recorded in 45 % of patients, and previous mental health diagnoses were almost three times as prevalent in this group compared to those of unclear intent (SDV: 42 % vs UI: 13 %). In the sex-based analysis females were more likely than males to have a history of depression (49 % vs 31 %, p < 0.0001). There were few sex differences in the SDV group but women of unclear intent were older, with a quarter being aged 65 years or over (Females: 26 % vs. Males: 11 %, p < 0.0001). Females of unclear intent were also more likely to have sustained a high level fall (Females: 29 % vs. Males:11 %, p < 0.001). Previous mental health co-morbidity was associated with self-directed violence in our cohort. Yet the determinants of intent for over half of the patients were unclear. Trauma clinicians should actively enquire regarding intent of injury and escalate to clinical psychology or psychiatry teams as indicated. Those with mental health comorbidities, previous depression and older women may all have an increased risk where intent is unclear and warrants further investigation. Understanding the predictors and characteristics of unclear intent and high-risk behaviours are key to implementation of public health strategies around prevention of self-directed violence and suicide.

Suicide Prevention training in pediatric primary care: A Scoping Review

Suicide Prevention training in pediatric primary care: A Scoping Review

619 Approaching continuity: increasing rates and improving perception in a pediatric primary care resident clinic

619 Approaching continuity: increasing rates and improving perception in a pediatric primary care resident clinic

Self-Perceived Barriers to Pediatric Cancer Care in Sub-Saharan Africa: A Cross-Sectional Multinational Study

PURPOSE The number of patients with childhood cancer (CC) in sub-Saharan Africa is expected to rise over the coming years. According to the WHO Initiative for Childhood Cancer, access to care is crucial and must be guided by the needs of patients and their families. Our study explored barriers to CC treatment from a patient's perspective to guide the health care providers. METHODS From February to September 2021, we conducted a multinational cross-sectional study with a sample from nine population-based cancer registries in nine sub-Saharan countries. Inclusion criteria comprised a cancer diagnosis according to the International Classification of Childhood Cancer, age 0-19 years, and year of diagnosis 2017-2019. A questionnaire was administered asking families about self-perceived barriers accessing surgery, radiotherapy, and chemotherapy. To assess associated factors, we conducted a multivariable regression analysis presenting the results as odds ratios (ORs). RESULTS A total of 224 patients with CC was included. The fear of treatment effects and the perceived (poor) health of the child were named most frequently as barriers for all treatment modalities (78.9% and 75.5%, respectively). For chemotherapy, respondents who indicated themselves as rich had lower odds of perceiving the (poor) health of the child as a barrier (OR, 0.06 [95% CI, 0.01 to 0.36]). For radiotherapy, long waiting time and (limited) availability in the country were more commonly barriers (OR, 7.53 [95% CI, 3.38 to 16.78]; OR, 11.11 [95% CI, 2.04 to 60.46], respectively) than for chemotherapy. CONCLUSION Despite known barriers such as the availability of therapy, our study additionally indicates the importance of the patients' and families' perceptions of the disease and its treatment. Further expanding measures of social support for affected families should be regarded as one of the main pillars to assure access to care.

Perspectives from parents and clinicians on an ecology-focused approach to a group well-child care

BackgroundGroup well-child care (GWCC) is a novel group-based alternative for pediatric primary care visits that may allow for adaptations that better tailor to the needs of underserved populations. This qualitative study investigates clinician and parent perspectives on the acceptability and feasibility of integrating ecology-focused content in GWCC using semi-structured interviews with GWCC parent-graduates and ecology-focused child clinicians.MethodsEcology-focused child clinicians were purposively sampled via email outreach. GWCC parent graduates were recruited via announcement in private Facebook groups. One-on-one interviews were conducted via videoconference, transcribed, and analyzed using an inductive approach. Parent and clinician thematic analyses were independently conducted to construct shared domains.ResultsNine GWCC parent-graduates and nine ecology-focused child clinicians were recruited into the study. Four overarching themes were constructed across parent and clinician responses: questions about clinical appropriateness, parent and clinician desires for educational support, influences of perceptions of nature on clinicians, and parent desires to develop independence and autonomy.ConclusionThis study identified nuanced considerations from the perspective of parents and clinicians for the implementation of ecology-focused content in the GWCC setting. Understanding the range of preferences parents and clinicians may have over ecology-focused content can help GWCC clinicians in designing ecology-focused preventive counseling materials.

Linking household members and defining relational networks using routine health data.

The growth of rich electronic health record (EHR) data and large health databases has introduced new opportunities to link individuals together into households and relational networks. These 'linked relational networks' hold promise for providing family-level care and studying intergenerational epidemiology and clinical outcomes. However, as linked relational networks become more commonly available in EHRs and research databases, it is critical to understand their challenges and limitations. Matching algorithms are being used to create linked relational networks in EHR and health databases. Clinically, these algorithms have been most useful to provide dyadic maternal-newborn care. In research, studies using these algorithms investigate topics ranging from the pharmacoepidemiology of parental drug exposure on childhood health outcomes, to heritability of chronic conditions, to associations between parental and child healthcare access and service delivery. However, ethical and technical challenges continue to limit use of these algorithms. There is also a critical research gap in the external validity of these matching algorithms. Linked relational networks are in widespread use in pediatric clinical care and research. More research is needed to understand the scope, limitations, and biases inherent in existing matching strategies.

Scope of practice of Japanese primary care physicians and its associated factors: a cross-sectional study

ObjectiveThe scope of practice (SOP) of primary care physicians (PCPs) has been narrowing, with declining comprehensiveness leading to fragmented care. Identifying SOP-associated factors can help improve comprehensiveness. This study aimed...

Socioeconomic disparities and trends in the utilization of regional and neuraxial anesthesia for pediatric femur fracture repair.

Pediatric femur fractures often necessitate surgical intervention, with pain management being critical for both immediate and long-term outcomes. Peripheral nerve blocks (PNBs) and neuraxial techniques are effective in providing targeted pain relief while minimizing systemic opioid exposure. Despite their benefits, the utilization of these anesthesia techniques in pediatric orthopedic surgeries is limited, particularly among socioeconomically disadvantaged patients. This study aims to evaluate the association between socioeconomic status (SES) and the use of regional and neuraxial anesthesia in pediatric femur fracture repairs, focusing on healthcare resource utilization (HRU) outcomes such as hospital length of stay (LOS), total hospital charges, and discharge disposition. Using the 2016-2020 NIS database, we identified 43,605 pediatric patients who underwent femur fracture repair. Only 1 % received PNB, and 0.1 % received spinal block (SB). Our analysis revealed that PNB was less likely to be administered to patients from lower SES backgrounds, those with subtrochanteric fractures, or those requiring delayed repair. Conversely, PNB was associated with reduced HRU, while SB was linked to increased HRU. The findings underscore significant disparities in the application of regional anesthesia, influenced by socioeconomic factors. Our study highlights the need for standardized guidelines and interventions to address these disparities, ensuring equitable access to effective pain management techniques in pediatric orthopedic care. Further research is warranted to understand the barriers to the utilization of PNB and to develop strategies to enhance its adoption, particularly among underserved populations.

Rhythmanalysis of care: Daily practices among informal caregivers of children with cancer.

An increasing number of people face the challenge of providing long-term, unpaid, informal care to children with cancer. The repetitive and staged processes of treatment create inherently rhythmic care practices, imposing a strict schedule on caregivers' daily routines. To explore the rhythmic nature of pediatric cancer informal care, we discuss the rhythms of daily life during intensive chemotherapy and maintenance therapy, and negotiated strategies of caring practice. We draw upon Lefebvre's rhythmanalysis and activity diary, and conduct semi-structured interviews with informal caregivers. We demonstrate the scale, stage, and dynamic nature of the daily life rhythm of caregivers of children with cancer, which is characterized by linear "alienation," arrhythmia, and "metastable" harmony. Structured therapeutic rhythms do not have overwhelming power; rhythms are intervened through insertion, negotiated adjustment, recharging, and alliances to maintain eurhythmia in caregivers of children with cancer. This study provides specific insights into the care of children with cancer in the context of the relationship between time, space, energy, and rhythm, which may help provide support to caregivers and reduce their burden of care.

A Preamble to Prevention of Adolescent Substance Use: Pediatric Resident Screening for Caregiver Substance Use.

Caregiver problematic substance use (SU) is a common adverse childhood experience that is associated with the development of SU disorders in adolescence and poor health outcomes. Most pediatricians do not currently screen for caregiver SU, missing an opportunity to provide targeted prevention counseling to at-risk youth and their families. The objective of this study was to assess whether pediatric residents' screening-related competencies, beliefs, and training were associated with current screening practices and/or preparedness to screen in the future. Baseline surveys from a quality improvement initiative to increase screening for household SU in pediatric primary care were e-mailed to all pediatric residents at an academic medical center. Surveys assessed residents' current screening practices, preparedness to screen in the future, screening-related competencies, receipt of SU training, beliefs about screening, perceived caregiver acceptability of screening, and stigma about caregiver SU. Residents agreed screening for household SU is a pediatrician's responsibility and beneficial for patients and families, yet only 5% universally screened. Preparedness to screen in the future was positively associated with reported screening-related competencies and receipt of training on SU screening during residency. Most residents did not universally screen for household SU, thereby missing opportunities for targeted secondary prevention of adolescent SU. Trained residents who reported competence in addressing families' concerns were more likely to feel prepared to screen in the future, suggesting education that addresses caring for affected families, reviews available resources, and improves pediatrician confidence may be particularly impactful.

Unleashing potential of microbial biosynthesis of monoterpenes via enzyme and metabolic engineering

Unleashing potential of microbial biosynthesis of monoterpenes via enzyme and metabolic engineering

Loop engineering of enzymes to control their immobilization and ultimately fabricate more efficient heterogeneous biocatalysts.

Enzyme immobilization is indispensable for enhancing enzyme performance in various industrial applications. Typically, enzymes require specific spatial arrangements for optimal functionality, underscoring the importance of correct orientation. Despite well-known N- or C-terminus tailoring techniques, alternatives for achieving orientation control are limited. Here, we propose a novel approach that tailors the enzyme surface with engineered His-rich loops. To that aim, we first solve the X-ray crystal structure of a hexameric alcohol dehydrogenase from Thermus thermophilus HB27 (TtHBDH) (PDB: 9FBD). Guided by this 3D structure, we engineer the enzyme surface with a new loop enriched with six His residues to control enzyme orientation. Molecular dynamics simulations reveal that the engineered loop's imidazole rings have greater solvent accessibility than those in native His residues, allowing for more efficient enzyme immobilization on certain metal chelate-functionalized carriers. Using carriers functionalized with iron (III)-catechol, the apparent Vmax of the immobilized loop variant doubles the immobilized His-tagged one, and vice versa when both variants are immobilized on carriers functionalized with copper (II)-imidodiacetic acid. His-tagged and loop-engineered TtHBDH show high operational stability reaching 100% bioconversion after 10 reaction cycles, yet the loop variant is faster than the His-tagged one.

Comparison of the incidence of vaginal cuff dehiscence by hysterectomy route and type based on experienced surgeons' outcome.

To analyze the rate of vaginal cuff dehiscence (VCD) by surgical approach and surgeons' experience. In this observational, retrospective, cohort study, rates of VCD were calculated based on surgical approach, and VCD clinical characteristics were analyzed. Surgical routes of laparotomy, laparoscopy, and robotic surgery were compared. All minimally invasive surgeries were performed or supervised by a Japanese Society of Gynecology Obstetrics Endoscopy-certified laparoscopic surgeon. There were 4864 hysterectomies in total: abdominal hysterectomies (n = 2578, 53.0%), laparoscopic hysterectomies (n = 1840, 37.8%), and robotic hysterectomies (n = 446, 9.2%). Among the 20 (0.411%) patients with VCD, the rate of VCD was highest for laparoscopic hysterectomy (0.706%), followed by robotic surgery (0.224%) and laparotomy (0.233%). Most causes of VCD were due to intercourse (50%), but 8 of 9 (88.8%) cases caused spontaneously or by defecation were laparoscopic cases. Defecation-related and spontaneous cases occurred significantly earlier after surgery than did intercourse-related cases (P = 0.008). Our data showed a decrease in laparoscopic VCD compared with those of previous reports. VCD occurred more frequently with laparoscopy than with laparotomy, even when performed by experienced surgeons. Laparoscopic VCD often develops early with little external force applied. Problems with vaginal stump rigidity may be related to the surgical procedure.

The trend of publications in the Journal of Conservative Dentistry and Endodontics: A 6-year systematic survey of the journal

Abstract Objectives: The Journal of Conservative Dentistry and Endodontics (JCDE) is an English-language journal published by the Indian Association of Conservative Dentistry and Endodontics. It was indexed in PubMed in 2010 in periodical publications. The purpose of this paper was to review and analyze the publications in JCDE over the 6 years from 2019 to 2024. Materials and Methods: This article evaluated the subject, number, and type of articles published, key topics addressed, authorship patterns, and article citations of the JCDE over the last 6-year period. Results: A total of 750 papers were found, and the publication output peaked in 2024 when 133 articles were published. On average, each volume had 1.5 times as many publications on endodontic topics compared to restorative topics. An average of eleven articles per volume addressed multidisciplinary or other dental disciplines. Original research articles followed by literature reviews and case reports/series accounted for the most articles per volume. The most of the authors were from India followed by the Middle East, America, and other Asian countries. With about 2802 citations, the 2019 issue had the most citations. Esthetic Dentistry was the main topic in the top 10 most cited articles. JCDE has the 7th-highest h5-index across both endodontic and operative dentistry journals. Conclusions: Many manuscripts in endodontics, dental materials, restorative dentistry, and a few other pertinent specializations have been published in JCDE over the past 6 years.

A Case of Non-Anastomotic Tracheo-Thoracic Gastric Fistula.

Tracheo-thoracic gastric fistula (TTGF) is a rare but serious complication following oesophageal cancer surgery, involving an abnormal connection between the thoracic gastric cavity and the bronchial tree. We report a case of TTGF that developed 3 years post-esophagectomy, identified through bronchoscopy. The patient was treated using a multidisciplinary approach, which included the placement of a bronchial covered stent, insertion of a jejunostomy feeding tube, and gastrointestinal decompression. The intervention resulted in a marked improvement in the patient's respiratory distress and fever, leading to a successful discharge. This case highlights the necessity for individualised treatment strategies for TTGF and underscores the crucial role of multidisciplinary management in enhancing patient outcomes.

Experiences and perspectives of patients undergoing colorectal cancer surgery: A qualitative study.

This study aimed to explore the experiences of patients with colorectal cancer undergoing surgical treatment, capturing their perspectives from diagnosis through to post-discharge recovery. A qualitative methodology was adopted, utilising semi-structured virtual interviews with ten patients recruited from a specialist colorectal clinic. Interviews were transcribed verbatim, and data analysed by the process of inductive thematic analysis, using interpretive description. Themes emerged across the domains of clinical and external, patient-level, and interpersonal and social factors affecting patient experience at diagnosis, surgery, and recovery stages. Clinical and external factors included the impact of the hospital environment, resource limitations, and the attributes of the clinical team, including ward nurses, clinical nurse specialists, and consultant surgeons, in providing compassionate support. Patient-level factors encompassed perceptions and emotional impacts of the diagnosis, and physical challenges post-surgery. Interpersonal and social factors included family support and the psychosocial impact of role changes during recovery. Findings highlight the need for comprehensive, compassionate communication and tailored support across the patient journey. Recommendations include enhanced patient education on lifestyle impacts, resources to support family and peer networks, and more attention to psychosocial and emotional challenges in patient-centred care.

Do Enhanced Recovery After Surgery (Erasâ) Protocols Improve Oncological Outcomes In Liver Cancer Surgery?: Preliminary Results

Do Enhanced Recovery After Surgery (Erasâ) Protocols Improve Oncological Outcomes In Liver Cancer Surgery?: Preliminary Results