Blood Draw Research Articles

Serum concentrations of per- and polyfluorinated substances and risk of B-cell non-Hodgkin lymphoma

Per- and polyfluoroalkyl substances (PFAS) are persistent organic pollutants that are detectable in the serum of most U.S. adults. Some studies of highly-exposed individuals have suggested positive associations between PFAS and B-cell non-Hodgkin lymphoma (B-NHL). To investigate whether associations exist at lower exposure levels, we conducted a nested case-control study investigating serum PFAS concentrations and B-NHL within the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. We measured pre-diagnostic serum concentrations of five PFAS among 706 cases (age at diagnosis = 55–93 years, median 73 years) and 706 controls individually matched on age at blood draw, sex, self-reported race and ethnicity, study center, and year of blood collection (the median follow-up years = 10). We estimated odds ratios (ORs) and 95 % confidence intervals (CIs) for PFAS concentrations in relation to B-NHL, both overall and for selected histologic subtypes [diffuse large B cell lymphoma (DLBCL), follicular lymphoma (FL), and marginal zone lymphoma (MZL)] using conditional logistic regression. We found no evidence of a positive association with B-NHL for any of the five PFAS. In analyses of histologic subtypes, perfluorohexane sulfonate (PFHxS) was significantly associated with DLBCL in a model adjusting for all other PFAS (OR for highest vs. lowest quintile = 2.19, 95 % CI = 1.21, 3.95; Ptrend = 0.02), but not in a model without mutual adjustment (OR = 1.37, 95 % CI = 0.82, 2.29; Ptrend = 0.26). We also observed an inverse association between perfluorononanoate and DLBCL (mutually-adjusted OR = 0.83, 95 % CI = 0.69, 0.99 per doubling in concentration), although the association was null among participants with blood drawn prior to 1997 (OR<1997 = 1.00, 95 % CI = 0.82, 1.21; OR≥1997 = 0.65, 95 % CI = 0.53, 0.79; Pinteraction = 0.0003). In conclusion, our findings from a prospective cohort study with PFAS serum concentrations comparable to that of the general population do not support an association with increased risk of B-NHL overall. The suggestive evidence of a positive association between PFHxS and DLBCL warrants further investigation.

Quantitative analysis of the impact of seasonal cyclicality on serum 25-hydroxycholecalciferol concentration in Northwest Arctic

Background: 25-hydroxycholecalciferol also known as 25-hydroxyvitamin D plays a vital role in numerous physiological functions within the human body, and its deficiency is associated with conditions such as osteoporosis, cardiovascular diseases, autoimmune disorders, and certain cancers. In Alaska, sunlight exposure is a critical factor that influences vitamin D levels in the population. Methods: This study involved a review of serum 25-hydroxyvitamin D [25(OH)D] levels from January 2014 to June 2018 for Alaska residents, including individuals aged 18 years or older who were permanent residents of the area. The exclusion criteria comprised acute or chronic liver or kidney dysfunction, anemia, cancer history, absorption deficiency, and vitamin D supplementation exceeding 500 IU/day within 90 days before the blood draw. Results: A total of 304 participants, including 107 males (35.2%) and 197 females (64.8%), with a mean age of 50.88, were included. The overall mean serum level of 25(OH)D was 22.7 ± 9.89 ng/mL. Females exhibited a higher mean level (23.40 ± 10.24 ng/mL) than males (21.03 ± 9.05 ng/mL) (P &lt;0.05). Participants older than 60 years had a higher average level of 25(OH)D (26.52 ± 10.28 ng/mL) compared to those younger than 45 years (19.85 ± 9.27 ng/mL) (P &lt; 0.05). Seasonal variations were observed, with levels below 20.0 ng/mL from October to March, below 30.0 ng/mL from April to May (insufficient), and slightly above 30.0 ng/mL (desirable) from June to August (P &lt; 0.0001). No significant intercommunity differences were found. Only 24.3% of the participants had a desirable vitamin D level. The association between the 25(OH)D level and the solar zenith angle was linear and markedly negative (r = −0.924; P &lt; 0.0001). Conclusions: This study demonstrates seasonal variations in 25(OH)D serum levels among the Alaska population. Further exploration of factors such as skin pigmentation, daily vitamin D intake, and body mass index is necessary to comprehensively understand the variation in 25(OH)D serum levels in this region.

Distress and inflammation are independently associated with cancer-related symptom severity

ObjectiveTo evaluate longitudinal associations of distress and inflammation with somatic and depressive symptom severity in breast cancer patients, from before to six months after neoadjuvant chemotherapy. We also explored feasibility and effects of an early mindfulness-based intervention for preventing or reducing somatic and depressive symptoms. MethodsLongitudinal pilot study with a randomized waitlist-controlled intervention design. Women with breast cancer were randomized to receive access to a smartphone application offering meditation exercises, either immediately after baseline testing (intervention group) or after study completion (control group) in a 1:1 ratio. Assessments (self-report questionnaires and a blood draw when feasible) were completed before, halfway through, immediately after, and 6 months after completing neoadjuvant chemotherapy. ResultsFifty evaluable women were enrolled. Somatic symptom severity increased during chemotherapy, whereas depressive symptom severity was at its peak before treatment and declined gradually thereafter. Distress was positively associated with depressive symptom severity. Only Distress Thermometer-results were positively associated with somatic symptom severity. Inflammation was positively associated with both types of symptoms, and distress did not moderate the associations between inflammation and symptom severity. Intervention adherence was low and no intervention effect on symptom experience was observed. ConclusionInflammation and distress are independently associated with somatic and depressive symptoms experienced during breast cancer treatment.

Exploring the Fundamentals of Bilirubinometry: Methods of Assessment, Timely Monitoring, and Intervention in Neonatal Jaundice with Integrated Phototherapy Solutions—A Review

A frequent ailment in infants, neonatal jaundice is characterized by high bilirubin levels and yellowing of the skin and eyes. It needs to be carefully managed to avoid serious consequences like kernicterus. The principles of bilirubinometry are examined in this review paper, with particular attention paid to different evaluation techniques, the value of prompt monitoring, and modern intervention approaches. Newborns may find it uncomfortable to undergo intrusive blood drawing as part of traditional bilirubin measurement methods. Transcutaneous bilirubinometry (TcB), on the other hand, provides a non-invasive substitute that improves monitoring effectiveness and lessens patient pain. The mainstay of care for newborn jaundice is still phototherapy, which uses light to change bilirubin into a form that is easier to excrete. The efficacy and safety of phototherapy have been enhanced by recent developments, especially about LED-based technology. The evaluation also looks at integrated phototherapy options that optimize therapeutic results and improve neonatal safety by combining automated treatment modifications with real-time bilirubin monitoring. To improve neonatal health outcomes and lessen difficulties related to hyperbilirubinemia, this review emphasizes the significance of timely and effective care of neonatal jaundice by synthesizing existing achievements and highlighting the incorporation of technology innovations

Metabolic Monitoring for Children and Adolescents Prescribed Second-Generation Antipsychotics: A Qualitative Study with Child Psychiatrists.

Introduction: Professional guidelines recommend that providers routinely monitor children prescribed second-generation antipsychotics (SGA) to reduce the risk of adverse metabolic events associated with the medication. Despite this guidance, many studies show low rates of monitoring compliance. In this study, we interviewed child psychiatrists for their views of possible barriers to monitoring. Methods: Semi-structured qualitative interviews, developed according to the Regehr model of influences upon patient-provider decision making, were conducted with child and adolescent psychiatrists in current practice and recruited by convenience and snowball sampling. Interviews were conducted through internet video meetings and were recorded. Interview data were analyzed following Framework Analysis qualitative methods. Results: We recruited and completed interviews with 17 psychiatrists. Patient-level barriers included travel difficulties, limited family time for health care appointments, patient fear of blood draws, and more. Provider-level barriers included professional judgment versus guideline guidance, perceived family burden, assumption of low-risk, short-term SGA use, and more. Organizational level barriers included lack of organizational mandates or incentives, limited appointment time per patient, lack of care coordination, lack of co-located labs, personnel turnover, and more. Barriers at the social and cultural level include stigma and low health literacy. Conclusion: These practicing prescribers provided a wide range of possible barriers to metabolic monitoring in children and adolescents prescribed SGAs. The next step is to explore which may be present in certain settings, and to pilot quality improvement interventions. Addressing barriers can reduce risk of metabolic disorders arising from long-term use of SGAs in children and adolescents.

Refinements in Clinical and Behavioral Management for Macaques on Infectious Disease Protocols.

Providing optimal clinical and behavioral care is a key component of promoting animal welfare for macaques and other nonhuman primates (NHPs) in research. This overlap between critical areas of management is particularly important for NHPs on infectious disease protocols, which often have unique challenges. For example, traditionally these NHPs were often housed alone, which can have behavioral and clinical consequences. However, in the past decade or so, considerable effort has been directed at modifying procedures in an effort to improve animal welfare for this group of NHPs. In this review, we examine some refinements that can positively impact the clinical and behavioral management of macaques on infectious disease studies, including increased social housing and the use of positive reinforcement techniques to train animals to cooperate with procedures such as daily injections or awake blood draws. We also discuss ways to facilitate the implementation of these refinements, as well as to identify logistical considerations for their implementation. Finally, we look to the future and consider what more we can do to improve the welfare of these animals.

Long-term immune response and antibody dynamics after SARS-CoV-2 vaccination in patients undergoing renal replacement therapy

Introduction and objective: The SARS-CoV-2 virus has triggered a global pandemic, particularly affecting individuals with comorbidities and those on renal replacement therapy. Vaccination has become a critical strategy, although evidence indicates suboptimal immunity in these groups compared to the general population. Material and methods: The study assessed the post-vaccination response in 121 patients undergoing renal replacement therapy and 104 control individuals. IgG antibody levels against glycoprotein S were measured twice: the first sample was collected 4–8 months after two vaccine doses, and the second sample 6–8 months after third dose. Results: In both groups, antibody titres significantly increased after the third vaccine dose, with no notable difference between the control and study groups after two vaccine doses (p &lt; 0.001). The findings revealed no statistically significant difference in antibody levels between the two groups. Furthermore, there was no significant difference in infection frequency after three vaccine doses (p = 0.072). Patients who contracted COVID-19 after the third vaccination had lower antibody levels during the first blood draw, suggesting a potential impact on immunity. Among dialysis patients, a correlation was found between IgG antibody titres (in the first blood draw) and a longer time interval between the first and second vaccine doses (p = 0.021). The regression analysis indicated that a 1-unit increase in antibody level resulted in a 0.1% reduction in the risk of infection. Conclusions: The results imply that achieving immunity comparable to the general population is possible among patients undergoing renal replacement therapy more than half a year after receiving three vaccine doses. The study also introduces the hypothesis of a delayed antibody response.

Intimate Partner Violence Among Three Key Populations at Risk of HIV in Panama

This study aims to estimate the prevalence of interpersonal personal violence (IPV) among three key populations at an increased risk of HIV in Panama (namely, transgender women, sex workers, and men who have sex with men [MSM]) and to estimate the positivity rate of four sexually transmitted infections (STIs), including HIV. Participants from the 2018 PEMAR study with a stable primary partner completed a 31-item survey with demographic data, the Spanish version of the four-item HITS questionnaire (being physically Hurt, Insulted, Threatened, or Screamed at; Cronbach’s α = .816), and an optional blood draw for STI testing. Prevalence rates of IPV were estimated with their respective 95% CIs after imputing 3.93% of missing values. The analytic sample (N= 356) included 76.0% MSM, 15.5% sex workers, and 9.3% transgender women, most of whom were in their 30s, married, and Latinx; completed some college; and worked full time. The most frequent forms of IPV were screams and insults. The IPV prevalence rates were estimated for transgender women (19.05%), sex workers (10.53%), and MSM (2.36%). Among participants who consented to blood samples (n= 291), transgender women who experienced IPV had a significantly (P= .03) higher syphilis positivity rate and MSM who did not experience IPV had a significantly (P&lt; .001) higher HIV positivity rate. Among key populations, transgender women experienced the highest rate of IPV and significantly higher syphilis rates. Paradoxically, HIV rates were higher among MSM who do not experience IPV. While societal roles and other contextual factors play a partial role in these syndemic findings, more studies are warranted.

Caloric Restriction Diet Attenuates Systemic Bone Fragility after Radiotherapy.

Bone fragility is a well-documented long-term side effect of radiotherapy, which currently has no preventative treatments. In this study, we applied a caloric restriction (CR) diet to attenuate both local and systemic bone loss after irradiation (RTx) in an established female Balb/c mouse model (4 consecutive daily doses of 5 Gy to the right hindlimb only). CR mice were tapered down to a 30% reduced calorie diet (RTx/CR) one week before irradiation, while regular diet (RD) mice received food ad libitum (RTx/RD). Unirradiated (sham) mice received either a 30% CR diet (SH/CR) or received food ad libitum (SH/RD). Irradiated, contralateral, and unirradiated hindlimbs were evaluated at 2, 4, and 8 weeks postirradiation using micro-computed tomography (μCT) to assess bone morphology and 3-point bending to quantify femur strength. Histological analysis of irradiated and unirradiated tibiae was performed to examine general bone tissue cytology and serum biomarker analysis was performed using terminal blood draw samples. After treatment, femur strength and metaphyseal bone quantity was decreased in irradiated and contralateral femora of RTx/RD mice compared to SH/RD femurs; this finding is consistent with previous studies. RTx/CR mice had positive effects when compared to RTx/RD mice, including increased strength relative to body mass in both the irradiated and contralateral limb, increased trabecular bone mass, and decreased marrow adiposity. However, a number of adverse effects were also observed, including a significant decrease in body mass and decreased cortical bone. Overall, CR shows promise as a preventative treatment for postirradiated bone fragility, yet questions remain to be addressed in future studies. Ideal diet duration, impact to normal tissue, and mechanism of action must be explored to better understand the clinical implication of a CR diet.

Abstract B059: Every day counts to cada dia cuenta: Adapting a behavioral intervention trial to accommodate Spanish language participants in a multisite study

Abstract Introduction. The number of women living with metastatic breast cancer (MBC) has doubled in the last decade. Hispanic women have lower incidence of breast cancer than non-Hispanic White women but are more likely to be diagnosed at an advanced stage. Targeted therapies can impose prolonged symptom burden resulting in significant distress and physical limitations for women with MBC. Minimizing symptom burden, while maximizing treatment response and quality of life (QoL) are the primary goals in the metastatic setting. Thus, the demand for evidence-based interventions to help improve QoL, prognosis and survivorship is critical. Every Day Counts (EDC) examines the impact of a diet and exercise intervention on QoL and explores potential mechanistic pathways (e.g., body composition, inflammation) linking lifestyle to QoL. Initially, study eligibility excluded non-English speakers. Given the burden of MBC among Latinas, including Spanish language participants was a priority; the process of achieving this goal is described herein. Methods: Participants complete surveys and physical assessments at baseline and are then randomized to the 16-week lifestyle intervention OR the attention control organizational program. Both are led by a trained coach and include a program binder and weekly text messages whereas only the intervention receives a Fitbit and cooking classes. After the16-week program, participants complete surveys and physical assessments, and the control group participants crossover to the lifestyle program. Surveys include QoL, diet, physical activity, pain, cognitive function, sleep, outcome expectancy, social support, mood, and self- efficacy. Physical assessments include a 24-hour diet recall, DEXA, 6-minute walk, sit-to-stand, handgrip, arm curl, single leg balance, and blood draw. Adapting the trial for Spanish language participants required multiple steps and was led and implemented by bilingual, bicultural staff that went beyond translation and back-translation. Material Inventory. Review participant- facing materials to inform plan for adaptation and translation. Survey Review (N=17). Identify which measures are available and validated in Spanish using Pubmed and other search engines and/or contacting instrument author(s). Intervention Review. Staff review for content relevance for Latinas, include images and recipes illustrative of Latina culture. Translation. The study used a translation/back-translation process for recruitment scripts and materials, consent form, all surveys not available in Spanish, physical assessment protocols, intervention and control materials and text messages. Translation Review. To ensure the context of translation across dialects common to the Midwest, materials were reviewed by community members (Mexico, Puerto Rico, Dominican Republic), with discrepancies resolved by staff. Discussion:: Transitioning studies to be more inclusive will increase critical access to much-needed trials that will impact disparities evident among minoritized communities. Citation Format: Diana L. Navarro Suarez, Patricia Sheean, Estefania Alonso, Sandra Contreras, Kathleen O’Connell, Margaret Tovar, Melinda Stolley. Every day counts to cada dia cuenta: Adapting a behavioral intervention trial to accommodate Spanish language participants in a multisite study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B059.

Abstract B068: Physical function and fitness of African American prostate cancer survivors at baseline of Men Moving Forward, a lifestyle intervention program

Abstract Background: Prostate cancer (PC) is the most commonly diagnosed cancer in American men with 1 in 8 men diagnosed in their lifetime. African American men have the highest rates of incidence and mortality for PC in the USA, due to a myriad of socio-biological factors. Fortunately, given advances in screening and treatment options the survival rate of PC is high with a 97% 5-year survival rate. However, PC treatments can cause muscle atrophy and reduced physical functioning and quality of life (QoL). Physical function and strength can serve as proxy measurements for cellular aging, longevity, and QoL. Handgrip is related to overall strength, upper limb function, bone mineral density, and mortality. Sit-to-stand measures leg strength and endurance and is used to evaluate fall risk. The 6-minute walk test (6MW) is used to assess aerobic capacity. Men Moving Forward (MMF) is one of the first community-based lifestyle programs developed with and for African American Prostate Cancer Survivors (AAPCS). This study examines objective and subjective physical function of MMF participants at baseline. Methods: MMF is a randomized, wait-list control trial with a 16-week group-based lifestyle intervention focused on physical activity, nutrition and QoL, led by local health coaches. Participants complete physical assessments and surveys at baseline, post-intervention and 12 months. Physical assessments consist of a blood draw, DXA scan, anthropometric measurements, handgrip strength, 30-second sit-to-stand, and 6MW (added with second cohort). Participants also answer surveys on their health and physical function. Pearson’s correlation was used to assess linear correlation between fitness measures and self-reported physical function. Results: At baseline, 100 AAPCS completed both the physical assessment and survey. Participants had a mean age of 65.8 ± 7.26 years, 49% were married/living with a partner, 47.6% were retired, and education levels varied. Top comorbidities include hypertension, obesity, diabetes, and hypercholesterolemia. Mean hand grip scores were 39.8 ± 7.5kg for right and 38.4 ± 7.7kg for left. Handgrip scores 28.2-44.0kg for men aged 64-69 are considered normal. Mean sit-to-stand (n=96) was 12.2 ± 4.3 reps in 30 seconds. Since 6MW was added later in the study, 68 men completed with a mean score of 0.42 ± 0.10 km. Normal ranges for men aged 65-69 is 15 reps for sit-to-stand and 0.572km for 6MW. 50% of participants rated their overall health as “good”, 21% as “very good”, and 20% as “fair” on a five-point Likert scale. PROMIS physical function measures had an average of 50.3 ± 7.3 for men at baseline. PROMIS physical function was weakly correlated with 6MW and sit-to-stand with r = 0.34, p-value=0.004 and r = 0.27, p- value=0.009, respectively. Conclusion: Data reflect the value of supporting AAPCS in lifestyle changes to improve physical function. Few efforts have addressed lifestyle among AAPCS, despite high prostate cancer burden. Future reports will examine the efficacy of MMF in improving physical function, overall health, and QoL. Citation Format: Margaret Y. Tovar, Iwalola Awoyinka, Patricia Sheean, Paula Papanek, Toni Uhrich, Sandra Contreras, Meheret Gebreegziabher, Estefania Alonso, Jayme Ewens, Shannon Reed, Diana Navarro Suarez, Kathleen O'Connell, Kathryn Flynn, Kathryn Bylow, Deepak Kilari, Melinda Stolley. Physical function and fitness of African American prostate cancer survivors at baseline of Men Moving Forward, a lifestyle intervention program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B068.

A Study to Evaluate the Effectiveness of Health Education Program on Knowledge Regarding CLABSI on B.SC. Nursing Students Studying in Sharda University, Greater Noida, Uttar Pradesh

Introduction: Central line-associated bloodstream infection (CLABSI) When a central artery is infected with pathogens or viruses, it can be quite serious. Healthcare providers may put a central line into one of the larger veins to give medicines, fluids, or blood products, or draw blood for lab tests that people need over a long period. A CLABSI is a laboratory-confirmed bloodstream infection not found to be present or incubating on admission and the patient has had a central line in place for &gt; =2 calendar days by the day of the event, with that same organism also being RECOGNIZED from one other sterile site. Aim: The study aimed to determine the effectiveness of the health education program or knowledge regarding CLABSI. Methodology: A quasi-experimental pretest one-group and post-test design was adopted. In this situation, the population of the study, and the inclusion, and exclusion criteria were applied. Use of sample size, sampling techniques, validation, and data collection participants Population of the study included all B.Sc. Nursing undergraduate students at Sharda University School of Nursing. Research incurred from May to June 2024. A purposive sampling strategy was used in the selection and determination of the sample size of the study which was 60 students using the independent t-test formula. Result: The study shows that 68.3% of the participants must have a poor level of knowledge. 23.3% had an average level of knowledge 8.3% had a good level of knowledge regarding the pretest, a maximum of 63.3% they were having a good level of knowledge, about 26.7% of them are having an average level of knowledge, 10% of them had a poor level of knowledge regarding it. From the pre-test to the post-test the mean knowledge score has significantly increased, in the pre-test was 9.83 S. D= 4.00 and in the post-test, it iwas 15.65 and S. D= 3.99. The Paired T-test value is -8.85 and the p-value is less than 0.01. Conclusion: According to the findings, nursing students need to have a comprehensive grasp of CLABSI to build an understanding of the illness state and to receive proper treatment to prevent the development of other life-threatening disorders and sepsis.

Infectious Diseases-Approved Virtual Reality Goggles for Common Procedures in Pediatric Surgical Patients.

Background/Objective: Virtual reality (VR) technology has been reported as effective in mitigating fear, anxiety, and pain in children undergoing various medical procedures. Our aim was to test the effectiveness of non-sponge-coated mobile phone-operated VR goggles approved by infectious diseases (ID) control in pediatric surgical patients. Methods: A prospective randomized trial in which pre-procedural and post-procedural heart rate, fear, and anxiety, and post-procedural pain were measured in pediatric surgical patients assigned to receive standard care versus standard care and VR goggles. The patients underwent line insertions, peripheral venipunctures for blood draws, drain removals, and wound care. Results: The control group and the intention-to-treat group were each randomly assigned twenty-four patients. Since eight patients who received VR goggles removed them prior to completion of the procedure, the study group included sixteen patients. In the study group, heart rate, fear, and anxiety scores were significantly lower after the procedure as compared to prior to the procedure. In the control group, these parameters were similar before and after the procedure. Post-procedural decrease in fear and anxiety was significant when comparing VR to control. However, despite better post-procedural physiological and emotional scores in the VR group as compared to control, the differences were not statistically significant. Pre-procedural anxiety was significantly higher in the study group. Conclusions: ID-approved VR goggles can reduce fear and anxiety associated with procedures commonly performed in pedicatric surgical patients. However, since increased baseline anxiety might be associated with VR, a higher benefit might be achieved if goggles were worn only by children who express a clear desire to use them.

Intact HIV Reservoir in Monocytes Is Associated With Cognitive Function in Virally Suppressed Women With HIV

Abstract Background Monocytes are susceptible to human immunodeficiency virus (HIV) infection, form HIV reservoirs, and contribute to central nervous system complications (eg, cognitive impairment) in virally suppressed women with HIV (vsWWH). However, it remains unknown if the quality and/or quantity of the monocyte reservoir contributes to cognition in vsWWH. Methods Sixty-two vsWWH (mean age = 56.1 years, SD = 7.1; 93% Black, non-Hispanic; all HIV RNA &amp;lt;250 copies/mL) completed a cognitive test battery, blood draw, and whole-blood immunophenotyping. Monocytes and CD4 T cells were isolated from a subset of 53 participants and the HIV reservoir was assessed using cell-specific intact proviral DNA assays (IPDA). Demographically adjusted z-scores were calculated for each outcome using data from participants without HIV in the Women's Interagency HIV Study. Cognitive outcomes of interest included domain-specific and global z-scores. Results Thirty-Eight percent of vsWWH had detectable intact HIV genomes in monocytes (median = 21.5 copies/million). Higher levels of intact HIV genomes per million monocytes were associated with poorer verbal memory (delayed recall, r = 0.55, P = .01; recognition, r = 0.46, P = .04), fine motor skills (r = 0.50, P = .03), and global function (r = 0.47, P = .04). Higher levels of intact HIV genomes in monocytes were associated with percent intermediate monocytes (r = 0.60, P = .008), and the ratio of intact per intermediate monocyte was associated with worse memory (r = −0.59, P = .008). There were no associations between CD4 reservoir and cognition. Conclusions The number of intact HIV genomes per million monocytes was related to poorer cognition and the percentage of intermediate monocytes. These findings suggest that the presence of HIV genomes in general do not relate to cognitive complications, but intact, and therefore potentially replication-competent HIV, may contribute to cognitive complications in vsWWH.

A Descriptive Study to Assess Neonatal Stress Behavior Among Preterm Neonates Admitted in NICU, Nehru Hospital, PGIMER, Chandigarh

Background Preterm neonates are repeatedly exposed to many stressors in initial days of life such as environmental stressor (light and noise) and caregiver interventions (weighing, oral and tracheal suctioning, drawing blood samples, etc.). If preterm neonates’ stress is not recognized and left untreated, there may be long-term effects. Objective To assess the neonatal stress behavior among preterm neonates admitted in neonatal intensive care unit (NICU), Nehru Hospital, PGIMER, Chandigarh. Methodology A descriptive study was conducted to assess neonatal stress behavior among preterm neonates admitted in NICU, Nehru Hospital, PGIMER, Chandigarh. Ethical clearance was taken from Institutional Ethics Committee of PGIMER, Chandigarh. Total 100 participants admitted in NICU during the period of July–December 2022 were enrolled for the study using consecutive sampling technique. Data was collected by interviewing mother using interview schedule. It comprised of sociodemographic cum clinical profile of the preterm neonate. Observation was made by using—(a) modified infant positioning assessment tool (IPAT), (b) neonatal stress scale, and (c) preterm neonate’s behavior assessment scale. Results The present study shows that 88% of the preterm neonates show moderate stress and 70% of preterm neonates exhibit suspected abnormal behavioral response in terms of autonomic visceral subsystems, while 54% of the preterm neonates show suspected abnormal behavioral response in terms of state regulation attention interaction subsystem. Conclusion The present study concluded that moderate stress level and suspected abnormal behavioral response were found among hospitalized preterm neonates.

Von Willebrand Factor Antigen, Biomarkers of Inflammation, and Microvascular Flap Thrombosis in Reconstructive Surgery.

Background: Microvascular flap surgery has become a routine option for defect correction. The role of von Willebrand factor antigen (VWF:Ag) in the pathophysiology of flap complications is not fully understood. We aim to investigate the predictive value of VWF:Ag for microvascular flap complications and explore the relationship between chronic inflammation and VWF:Ag. Methods: This prospective cohort study included 88 adult patients undergoing elective microvascular flap surgery. Preoperative blood draws were collected on the day of surgery before initiation of crystalloids. The plasma concentration of VWF:Ag as well as albumin, neutrophil-to-lymphocyte ratio (NLR), interleukin-6, and fibrinogen were determined. Results: The overall complication rate was 27.3%, and true flap loss occurred in 11.4%. VWF:Ag levels were higher in true flap loss when compared to patients without complications (217.94 IU/dL [137.27-298.45] vs. 114.14 [95.67-132.71], p = 0.001). Regression analysis revealed the association between VWF:Ag and true flap loss at the cutoff of 163.73 IU/dL (OR 70.22 [10.74-485.28], p = 0.043). Increased VWF:Ag concentrations were linked to increases in plasma fibrinogen (p < 0.001), C-reactive protein (p < 0.001), interleukin-6 (p = 0.032), and NLR (p = 0.019). Conclusions: Preoperative plasma VWF:Ag concentration is linked to biomarkers of inflammation and may be valuable in predicting complications in microvascular flap surgery.

Full connected layer model with self-attention to hourly predict heparin dosage for perioperative cardiac surgery patients

BackgroundAnticoagulant therapy for patients who underwent cardiac surgery is a challenge. Both inadequate and excessive anticoagulation can cause fatal complications. Previous studies failed to provide real-time guidance for heparin pump speed adjustment. This study intended to provide a quantitative prediction model to optimize heparin dosage for cardiac surgery patients based on machine learning method. MethodsPatients who underwent cardiac surgery and admitted to intensive care unit in Peking Union Medical College Hospital (PUMCH) from January 2013 to December 2023 were retrospectively analyzed. In order to reach target activated partial thromboplastin time (aPTT), linear regression, SVM, XGBoost, LSTM, GRU, FC (Full Connected Layer) and FC + self-attention models were used to make hourly adjustment recommendation for administrations of heparin pump speed. Mean absolute square, and absolute percentage errors were used to evaluate the reliability of the models. SHAP method and feature cumulative effect were used to interpret the features of the FC + self-attention model. Safety and economic evaluation based on clinical compliance of this real-world data-oriented model was further analyzed. ResultsA total of 1080 patients including 112,554 heparin pump administrations were included in this study. Among seven candidate models, FC + self-attention model yielded the lowest mean absolute error of 0.9388 and 1.1325 in test and validation cohort. Gap to target aPTT, thrombin time, history of coronary heart disease, previous duration of arterial fibrillation and prothrombin activity were identified as important features affecting heparin adjustment. High compliance to FC + self-attention model may increase percentage of normal therapeutic time and decrease supratherapeutic therapeutic time and reducing blood draw until two consecutive normal therapeutic stabilization of aPTT. ConclusionsThis FC + self-attention model is potentially applicable for giving recommendation for healthcare providers to optimize heparin dosage for cardiac surgery patients.

Suppression of the DNA repair enzyme NEIL2 promotes persistent inflammation and genomic damage in subjects with stable COPD and during severe exacerbations.

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory airway disease that is an independent risk factor for lung cancer. NEIL2, a DNA glycolase involved in DNA repair during transcription, has also been associated with an increased incidence of malignancies in humans. NEIL2 knockout mouse models have demonstrated increased inflammation and oxidative DNA damage in the lungs after exposure to an inflammatory insult, but data are lacking regarding NEIL2 function in individuals with stable COPD and during severe acute exacerbations of COPD (AECOPD). We investigated whether NEIL2 levels and oxidative DNA damage to the transcribed genome are altered in individuals with stable COPD and AECOPD. The study was conducted at a single center in the US. Eligible subjects underwent a one-time 30 cc venous blood draw. The population consisted of 50 adults: 16 with stable COPD, 11 hospitalized for AECOPD, and 23 volunteers. We analyzed blood leukocytes for NEIL2 mRNA and DNA damage by RT-qPCR and LA-qPCR, respectively, in all groups. Plasma levels of seven biomarkers, CXCL1, CXCL8, CXCL9, CXCL10, CCL2, CCL11 and IL-6, were analyzed in the COPD groups using a magnetic bead panel (Millipore®). The NEIL2 mRNA levels were lower in individuals with stable COPD and AECOPD than in controls (0.72 for COPD, p = 0.0289; 0.407 for AECOPD, p = 0.0002). The difference in NEIL2 mRNA expression between the stable COPD group and AECOPD group was also statistically significant (p < 0.001). The fold change in DNA lesions per 10 kb of DNA was greater in the stable COPD (9.38, p < 0.0008) and AECOPD (15.81, p < 0.0004) groups than in the control group. The difference in fold change was also greater in the AECOPD group versus stable COPD p < 0.0236). Biomarker levels were not significantly different between the COPD groups. NEIL2 levels were correlated with plasma eosinophil levels in the stable COPD group (r = 0.737, p < 0.0027). NEIL2 mRNA levels are significantly reduced in COPD subjects and are associated with increased DNA damage and inflammation. These results reveal a mechanism that promotes persistent airway inflammation and oxidative genomic damage and increases the risk of malignancy in this population.

Molecular Markers, Immune Therapy, and Non-Small Cell Lung Cancer-State-of-the-Art Review for Surgeons.

Background: Lung cancer is a leading cause of cancer deaths in the United States. An increasing understanding of relevant non-small cell lung cancer (NSCLC) biomarkers has led to the recent development of molecular-targeted therapies and immune checkpoint inhibitors that have revolutionized treatment for patients with advanced and metastatic disease. The purpose of this review is to provide surgeons with a state-of-the-art understanding of the current medical and surgical treatment trends and their implications in the future of management of NSCLC. Materials and Methods: A systematic search of PubMed was conducted to identify English language articles published between January 2010 and March 2024 focusing on molecular markers, tumor targeting, and immunotherapy in the diagnosis and treatment of NSCLC. Case series, observational studies, randomized trials, guidelines, narrative reviews, systematic reviews, and meta-analyses were included. Results: There is now increasing data to suggest that molecular-targeted therapies and immune therapies have a role in the neoadjuvant setting. Advances in intraoperative imaging allow surgeons to perform increasingly parenchymal-sparing lung resections without compromising tumor margins. Liquid biopsies can noninvasively detect targetable mutations in cancer cells and DNA from a blood draw, potentially allowing for earlier diagnosis, personalized therapy, and long-term monitoring for disease recurrence. Conclusions: The management of NSCLC has advanced dramatically in recent years fueled by a growing understanding of the cancer biology of NSCLC. Advances in medical therapies, surgical techniques, and diagnostic and surveillance modalities continue to evolve but have already impacted current treatment strategies for NSCLC, which are encompassed in this review.

A Scoping Review of Audiovisual Distraction Techniques Among Children in Reducing Invasive Procedure Pain.

Invasive procedures in children can lead to painful and uncooperative procedures. It is essential to determine the appropriate method to create a comfortable environment for children during invasive procedures. However, audiovisuals are one of the distraction techniques used in pain management. This study aims to identify and categorize related audiovisual distraction techniques in reducing pain due to invasive procedures among children. This study uses a systematic scoping review. A literature review was conducted using PubMed, EBSCO, Science Direct, Scopus and grey literature through Google Scholar. The study was eligible for inclusion if it included articles published from 2012 to 2022, full-text and open accessed articles, and in Indonesian and English language. Studies were excluded if they were review studies and the adult population. The keywords in English were "Children" OR 'Child' OR"Kids" OR 'Youth' OR 'Adolescents' OR 'Teenager' OR 'Teens' OR 'Young People' OR 'Pediatric' OR 'Paediatric' OR 'Childhood' AND"Audiovisual" OR 'Movie' OR 'Video' OR 'Animation' AND"Pain" AND"Invasive procedures" and keyword in Indonesia were"Anak" OR 'Remaja' OR 'Bayi' OR 'Balita' AND"Audiovisual" OR 'Film' OR"Video" OR 'Animasi' OR "Nyeri" AND 'Prosedur invasif'. We found 15 articles showing audiovisual distraction techniques in managing pain among children undergoing invasive procedures. Three types of audiovisual interventions were used, including virtual reality (VR), video music, and animated cartoons. In addition, types of invasive procedures that benefited from the analyzed interventions were infusion, surgery, injection, blood draw, dressing change, circumcision, endoscopy, and phlebotomy. Our findings highlight that virtual reality, video music, and animated cartoons have clinical implications in helping to distract from pain in children undergoing invasive procedures. Our study indicates that the potential of audiovisual intervention can be used as an intervention strategy in the pediatric nursing area.