ChemInform Research Articles

Long-term outcomes of sentinel lymph node navigation surgery for early-stage cervical cancer.

Sentinel lymph node navigation surgery, which identifies the sentinel lymph node in early cervical cancers and omits systemic pelvic lymphadenectomy in cases where no lymph node metastasis is present, has recently gained attention. However, there are few reports on lymph node recurrence and the long-term outcomes of cervical cancer surgery performed using sentinel lymph node navigation surgery. In this study, we aimed to evaluate the long-term outcomes of sentinel node navigation surgery for early-stage cervical cancer. One hundred thirty-eight patients with cervical cancer were enrolled. Sentinel lymph nodes were identified by injecting 99m Technetium-labeled phytate and indocyanine green into the uterine cervix. Surgery and survival outcomes were also analyzed. The median age and body mass index of the patients were 40years (20-78) and 21.7kg/m2 (16.5-50.4), respectively. Open surgery, laparoscopic surgery, and robotic surgery were performed in 77 (56%), 53 (38%), and 8 (6%) patients, respectively. The overall and bilateral detection rates of the sentinel lymph node were 100% and 94%, respectively. Only one case (0.7%) exhibited lower extremity lymphedema, and pelvic lymphocele was observed in three cases (2.2%). Four cases (3%) experienced recurrence over a median follow-up of 57.5months (range, 2-115months), with five-year recurrence-free and overall survival rates of 97% and 97.3%, respectively. Our results demonstrate that sentinel node navigation surgery may be safe and effective for early-stage cervical cancer.

Sex- and gender-based medicine in pediatric nutrition.

Consistent evidence increasingly highlights the significance of integrating sex and gender medicine to ensure a precision approach according to individual patient needs. Gender discrepancies emerge across various areas, even from pediatric age. The importance of recognizing these differences in pediatric nutrition is critical for the development of targeted nutritional strategies and interventions, particularly in cases of associated pathologies, including obesity, metabolic-associated fatty liver disease, eating disorders, and inflammatory bowel disease. The review highlights the biological and sociocultural factors that contribute to different nutritional needs and health outcomes in male and female children. By examining current evidence, we underscore the necessity for precision medicine approaches in pediatric care that consider these sex- and gender-based differences. Moreover, differences in dietary requirements and dietary patterns between males and females are evident, underscoring the need for precise nutrition strategies for a more accurate management of children and adolescents. This approach is essential for improving clinical outcomes and promoting equitable healthcare practices. This review aims to provide an overview of nutrition-related medical conditions exhibiting sex- and gender-specific discrepancies, which might lead to distinct outcomes requiring unique management and prevention strategies. Future research and public health initiatives should address these differences in designing effective lifestyle education programs and nutrition interventions targeting both children and adolescents.

Rapid lateral flow test for Mycobacterium tuberculosis complex and non-tuberculous mycobacteria differentiation.

The diagnosis of mycobacterial infections, including both the Mycobacterium tuberculosis complex (MTBC) and non-tuberculous mycobacteria (NTM), poses a significant global medical challenge. This study proposes a novel approach using immunochromatographic (IC) strip tests for the simultaneous detection of MTBC and NTM. Traditional methods for identifying mycobacteria, such as culture techniques, are hindered by delays in distinguishing between MTBC and NTM, which can affect patient care and disease control. Molecular methods, while sensitive, are resource-intensive and unable to differentiate between live and dead bacteria. In this research, we developed unique monoclonal antibodies (mAbs) against Ag85B, a mycobacterial secretory protein, and successfully implemented IC strip tests named 8B and 9B. These strips demonstrated high concordance rates with conventional methods for detecting MTBC, with positivity rates of 93.9% and 85.9%, respectively. For NTM detection, the IC strip tests achieved a 63.2% detection rate compared to culture methods, considering variations in growth rates among different NTM species. Furthermore, this study highlights a significant finding regarding the potential of MPT64 and Ag85B proteins as markers for MTBC detection. In conclusion, our breakthrough method enables rapid and accurate detection of both MTBC and NTM bacteria within the BACTEC MGIT system. This approach represents a valuable tool in clinical settings for distinguishing between MTBC and NTM infections, thereby enhancing the management and control of mycobacterial diseases. KEY POINTS: • Panel of mAbs for differentiating MTB versus NTM • IC strips for diagnosing MTBC and NTM after the BACTEC MGIT • Combined detection of MTP64 and Ag85B enhances diagnostic accuracy.

Primary care quality and provider disparities in China: a standardized-patient-based study

BackgroundPrimary health care is the foundation of high-performing health systems. Achieving an improved primary care system requires a thorough understanding of the current quality of care among various providers within the system. As the world’s largest developing country, China has made significant investments in primary care over the past decade. This study evaluates the quality of primary care across different provider types in China, offering in- sights for enhancing China’s primary care system. MethodsWe merged data from four standardized patient (SP) research projects to compare the quality of five major primary care providers in China: rural clinics, county hospitals, migrant clinics, urban community health cen- ters (CHCs), and online platforms. We evaluated quality of care across process quality (e.g., checklist completion), diagnosis quality (e.g., diagnostic accuracy), and case management (e.g., correct medication), employing multiple regression analyses to explore quality differences by provider type, and their associations with physician characteristics. FindingsWe document a poor quality of primary care in China, with no- table disparities across different providers. CHCs emerge as relatively reliable primary care providers in terms of process quality, diagnostic accuracy, and cor- rect medication prescriptions. Online platforms outpace rural clinics, county hospitals, and migrant clinics in many areas, showcasing their potential to en- hance access to quality healthcare resources in under-resourced rural regions. We observe a positive association between the qualifications of physicians and the quality of primary care, underscoring the necessity for a greater presence of more highly qualified practitioners. InterpretationPrimary care quality in China varies greatly among providers, reflecting inequalities in healthcare access. While online platforms indicate po- tential for improving care in under-resourced areas, their high referral rates suggest they cannot completely substitute traditional care. The findings em- phasize the need for more qualified practitioners and stringent regulation to enhance care quality and reduce unnecessary treatments. FundingNo founders had a role in the study design, data collection, data analysis, data interpretation, or writing of the report. We have acknowledged this in the revised manuscript.

Biochar Amendment and its Impacts on Medicinal and Aromatic Plants in Sustainable Agriculture

Introduction: Biochar application and research have experienced a significant increase in recent decades. It can produce different kinds of organic materials, and it can be employed for different purposes, such as soil conditioning, carbon sequestration and filtration of pollutants from gas and aqueous media. Biochar is a C-rich material, which can be obtained from different types of organic feedstock, such as animal manure, sewage sludge, wood and crop residues and other organic waste. It is also considered an environmentally friendly and resource-saving approach in medicinal and aromatic plants production. Biochar can lead to plant growth improvement and influence on chemical components of medicinal plants, stimulate the growth of soil microflora, increase soil carbonsequestration, bioremediation of soil, regulate carbon fluxes between atmosphere and biosphere, reduce biotic stress in plants, improve soil nutrient availability, decrease abiotic stress in plants, wastewater treatment, immobilization and sorption of soil heavy metal contaminants. Methods: Relevant literature has been obtained using the keywords “biochar”, “organic amendment”, “soil quality”, “medicinal Plants”, “natural products”, “soil quality”, “macronutrient”, and “chemical components” in scientific databases, such as “PubMed”, “SciFinder”, “Elsevier”, and “Web of Science”. Results: The aim of this literature review is to study the impact of different kinds of biochars on medicinal and aromatic plants, soil quality and soil fertility by considering case studies of successful paradigms. Conclusion: Conclusively, we consider our review article will provide an appropriate guide for practitioners and researchers for future studies as well as large-scale field applications.

Top 100 Most Cited Articles on the use of Ozone in Dentistry: Bibliometric Analysis

Introduction: c density (number of citations per year), first author's country, year of publication, study design and subject. VOSviewer software was used to create graphical bibliometric maps. Results: The total number of citations papers which from 13 to 180, and only eight were cited more than 100 times. Papers were published from 1997 to 2022, mainly in dentistry journals. The studies originated from 30 different countries and the most papers were from Germany (16%) and Turkey (15%). In total, 250 keywords were used and the most used were ozone 50 (20%), dentistry 8 (3,2%) and periodontitis 7 (2,8%). Conclusions: 1) Germany was the main country that contributed to field research on the use of ozone in dentistry 2) The University of Basel was the most productive university in the researched field; 3) Clinical Oral Investigations was the journal that led the ranking with the most articles published, 4) The keyword ozone was the most used in the articles; 5) Oral and maxillofacial surgery was the research area most addressed by the 100 most cited articles.

Knowledge structure and research hotspots on digital scanning for implant-supported complete-arch prosthesis: A bibliometric analysis

BackgroundDigital scanning is increasingly widely used for implant-supported complete-arch prosthese. However, a quantitative literature analysis is lacking for this field. This study aims to conduct a bibliometric analysis to summarize the knowledge structure and research hotspots of digital scanning for implant-supported complete-arch prosthesis. Materials and methodsRelevant articles and reviews, published between 1994 and 2023, were obtained from the Web of Science Core Collection (WoSCC). Indicators such as publication count, annual growth, citation count, co-citation count, impact factor, Journal citation reports (JCR) division, H-index are used to assess the contribution of countries, journals, authors or the quality of articles. Visual maps, cluster analysis and keyword cloud are used to evaluate the cooperation pattern and topic trends. Results580 eligible publications, including 555 articles and 25 reviews, were analyzed. The United States is the leading country in this area, received the most citations. The Journal of Prosthetic Dentistry is the scientific journal with the highest impact. The analysis of keywords and ongoing trials shows that the accuracy of relevant techniques is a current hot topic in this field. ConclusionIn recent years, digital scanning technique for implant-supported complete-arch prosthesis has made rapid progress. By reviewing the published literature, we found the United States is the global leader in the field of digital scanning for complete-arch implant prosthesis. Accuracy is the core word in this field, more scientific evidence is needed to support the clinical application of digital scanning in this field.

53009 Outcomes of Cutaneous Surgery for Nonmelanoma Skin Cancer in Patients with Different Fitzpatrick Skin Types: A Nationwide, Multicenter, Prospective Study

53009 Outcomes of Cutaneous Surgery for Nonmelanoma Skin Cancer in Patients with Different Fitzpatrick Skin Types: A Nationwide, Multicenter, Prospective Study

52968 Association of Time to Definitive Surgery with Outcomes in Mohs Micrographic Surgery for Non-Melanoma Skin Cancers: A Retrospective Cohort Study

52968 Association of Time to Definitive Surgery with Outcomes in Mohs Micrographic Surgery for Non-Melanoma Skin Cancers: A Retrospective Cohort Study

Inaccurate Clinical Stage is Common and Associated With Poor Survival in Patients With Lung Cancer

IntroductionClinical staging in lung cancer has implications for treatment planning and prognosis. We sought to determine the rate of inaccurate clinical stage (relative to pathologic), identify risk factors for inaccuracy, and evaluate the association of inaccuracy on survival. We hypothesized that inaccurate staging was associated with poor survival. MethodsIn this retrospective cohort study, adult patients who received surgical resection without neoadjuvant treatment for nonsmall cell lung cancer from 2004 to 2020 in the National Cancer Database were categorized by accuracy of clinical stage (relative to pathologic stage). Multivariate models were used to determine risk factors for inaccuracy. The association between inaccuracy and overall survival was also analyzed. ResultsWe identified 255,598 patients with lung cancer, including 84,543 patients (33.1%) who were inaccurately staged. Stage inaccuracy was associated with higher tumor, node, metastasis stage (T-category 3: odds ratio [OR] = 1.2, 95% confidence interval [CI] 1.15-1.28; N-category 2: OR = 2.6, 95% CI 2.47-2.79), greater quantity of lymph nodes evaluated, and more extensive resection (extended lobectomy/bilobectomy: OR = 1.3, 95% CI 1.20-1.37; pneumonectomy: OR = 1.6, 95% CI 1.54-1.74). Patients undergoing robotic surgery were less likely to be inaccurately staged (OR = 0.89, 95% CI 0.852-0.939). Inaccurate staging was associated with worse overall survival (5-y 67.5% accurate versus 55.4% inaccurate, P < 0.001). Inaccurate staging was also associated with worse survival in a multivariate Cox model (hazard ratio [HR] = 1.3, 95% CI 1.29-1.33). Both “understaging” (path > clinical) and “overstaging” (clinical > path) were associated with inferior survival. ConclusionsInaccurate clinical stage (relative to pathologic) occurs in one-third of patients receiving surgery for lung cancer. Inaccuracy is associated with poor survival. Quality improvement initiatives should focus on improving clinical staging accuracy.

Prognostic Impact of Each Item of the SARC-F Questionnaire in Patients Undergoing Major Surgery for Urologic Cancer

Prognostic Impact of Each Item of the SARC-F Questionnaire in Patients Undergoing Major Surgery for Urologic Cancer

Developing a comprehensive curriculum program for nurse practitioners delivering primary care in the long-term care setting.

In the Long-Term Care (LTC) setting, comprehensive primary care is often provided by Nurse Practitioners (NPs). NPs are uniquely positioned to meet the evolving primary care needs of LTC residents. However, caring for this population requires additional education and training due to its special considerations. To meet the learning needs of NPs entering the LTC workplace, a Certificate Program was designed to enhance primary care competencies within the LTC setting. The aim of the program is to increase knowledge, capacity, and confidence of NPs to deliver quality, evidence-based, integrated, and interprofessional primary care to LTC residents. This curriculum is anticipated to address the growing need for LTC services and improve the delivery of high-quality primary care.

High-flow nasal cannula in Spanish Pediatric Intensive Care Services: A national web survey about its use and indications

ObjectiveTo describe the high-flow nasal cannula (HFNC) indications in the Spanish pediatric critical care units (PICUs). DesignDescriptive cross-sectional observational study. SettingElectronic survey among members of the Spanish Society of Pediatric Intensive Care (SECIP). It was sent weekly from April 10, 2023, to May 21, 2023. ParticipantsAll SECIP members. InterventionsNone. Main variables of interestThe questions focused on workplace, years of experience, use or non-use of HFNC, justification and expectations regarding its application, starting point within each center, clinical criteria for indication, existence of clinical guidelines, evaluation during its use, and criteria and mode of withdrawal. ResultsTwo hundred and two participants, 176 were from Spain. Of these, 87/176 had over ten years of experience. One hundred sixty two use HFNC and 66/162 have HFNC clinical guidelines. Acute bronchiolitis (138/162) and respiratory assistance after extubation (106/56) are the two main indications. For 62/162 HFNC may reduce therapeutic escalation. Neuromuscular diseases (105/162) and anatomical airway diseases (135/162) are the two main contraindications. The reasons to do not use HFNC were the absence of evidence about it effectiveness (8/14) and its inadequate cost/effectiveness balance (8/14). ConclusionsA majority of Spanish pediatric intensivists use HFNC. Its application and withdrawal appears to be primarily based on clinical experience. Besides, those who use HFNC are aware of its limitations and the lack of evidence in some cases. It is necessary to develop single-center and multicenter studies to elucidate the effectiveness of this therapy in the context of critically ill children.

Avoiding the needle: A quality improvement program introducing apixaban for extended thromboprophylaxis after major gynecologic cancer surgery

ObjectivePatients undergoing gynecologic cancer surgery at our centre are recommended up to 28 days of enoxaparin for extended post-operative thromboprophylaxis (EP). Baseline survey revealed 92% patient adherence, but highlighted negative effects on patient experience due to the injectable route of administration. We aimed to improve patient experience by reducing pain and bruising by 50%, increasing adherence by 5%, and reducing out-of-pocket cost after introducing apixaban as an oral alternative for EP. MethodsIn this interrupted time series quality improvement study, gynecologic cancer patients were offered a choice between apixaban (2.5 mg orally twice daily) or enoxaparin (40 mg subcutaneously once daily) at time of discharge. A multidisciplinary team informed project design, implementation, and evaluation. Process interventions included standardized orders, patient and care team education programs. Telephone survey at 1 and 6 weeks and chart audit informed outcome, process, and balancing measures. ResultsFrom August to October 2022, 127 consecutive patients were included. Apixaban was chosen by 84%. Survey response rate was 74%. Patients who chose apixaban reported significantly reduced pain, bruising, increased confidence with administration, and less negative impact of the medication (p < 0.0001 for all). Adherence was unchanged (92%). The proportion of patients paying less than $125 (apixaban cost threshold) increased from 45% to 91%. There was no difference in bleeding and no VTE events. ConclusionsIntroduction of apixaban for EP was associated with significant improvement in patient-reported quality measures and reduced financial toxicity with no effect on adherence or balancing measures. Apixaban is the preferred anticoagulant for EP at our centre.

From Oncogenesis to Theranostics: The Transformative Role of PSMA in Prostate Cancer

Prostate cancer, a leading cause of cancer-related mortality among men, is characterized by complex genetic and epigenetic alterations, dysregulation of oncogenic pathways, and a dynamic tumor microenvironment. Advances in molecular diagnostics and targeted therapies have significantly transformed the management of this disease. Prostate-specific membrane antigen (PSMA) has emerged as a critical biomarker, enhancing the precision of prostate cancer diagnosis and treatment. Theranostics, which integrates PSMA-targeted imaging with radioligand therapies, has shown remarkable efficacy in detecting and treating advanced prostate cancer. By leveraging the dual capabilities of PSMA-based diagnostics and therapeutic agents, theranostics offers a personalized approach that improves patient outcomes. This comprehensive review explores the latest developments in PSMA-targeted theranostics and their impact on the future of prostate cancer management, highlighting key clinical trials and emerging therapeutic strategies.

Early Postoperative Patient-Reported Outcomes of Sarcopenia Versus Nonsarcopenia in Patients Undergoing Video-Assisted Thoracoscopic Surgery for Lung Cancer.

To compare early postoperative patient-reported outcomes between sarcopenic and nonsarcopenic patients undergoing video-assisted thoracoscopic surgery (VATS) for lung cancer. The data used in this study were acquired from a longitudinal prospective study (CN-PRO-Lung 1) between November 2017 and January 2020. Skeletal muscle index was measured at L3 vertebral level on preoperative computed tomography to identify sarcopenia based on an established threshold. Symptoms severity and status of functional impairments were reported as proportions of patients with clinically relevant moderate-to-severe scores on 0-10 scales, which were measured by using the MD Anderson Symptom Inventory-Lung Cancer at baseline, daily postoperative hospitalization, and weekly after discharge up to 4 weeks. Symptom severity, functional status, and postoperative clinical outcomes were compared between the sarcopenia and nonsarcopenia groups. This study included 125 patients undergoing VATS for lung cancer. Sarcopenia was identified in 34 (27.2%) patients. Sarcopenic patients reported more moderate-to-severe pain (P = 0.002) at discharge and more moderate-to-severe fatigue (P = 0.027) during the 4 weeks after discharge. Besides, sarcopenic patients had a longer recovery time from both pain (P = 0.002) and fatigue (P = 0.007) than nonsarcopenic patients. Meanwhile, no significant between-group difference was found in the postoperative clinical outcomes (all P > 0.05). Sarcopenic patients undergoing VATS for lung cancer may have more pain and fatigue, as well as longer symptoms recovery time than nonsarcopenic patients during the early postoperative period.

Amoxicillin vs. placebo to reduce symptoms in children with group A streptococcal pharyngitis: a randomized, multicenter, double-blind, non-inferiority trial.

Placebo appears to be non-inferior to amoxicillin in reducing fever duration. Pain intensity and risk of complications were similar between the two groups. These findings support the restrictive antibiotic treatment for streptococcal pharyngitis. • Group A streptococcus pharyngitis is a common reason for prescribing antibiotics in pediatric care. • In high-income countries, while antibiotic treatment has not been effective in preventing non-suppurative complications, the primary justification for their use remains the reduction of symptoms. • Our results suggest that antibiotics have a limited impact on the duration of fever and the intensity of pain in children with streptococcal pharyngitis. • Considering that suppurative complications can be promptly treated if they arise, we recommend a more judicious approach to antibiotic prescriptions. The trial is registered at the US National Institutes of Health (ClinicalTrials.gov) # NCT03264911 on 15.08.2017.

The impact of long-course chemoradiotherapy on the myenteric plexus, neuromuscular functions and responses to prokinetic drugs in the human rectum.

The long-term effects of chemoradiotherapy on human rectum are poorly understood. The aims were to investigate changes in inflammatory status, myenteric neuron numbers/phenotype, neuromuscular functions and prokinetic drug efficacy. Macroscopically normal proximal-to-mid rectum was obtained from 21 patients undergoing surgery for bowel cancer, 98days (range: 63-350) after concurrent capecitabine and pelvic radiotherapy, and 19 patients without chemoradiotherapy. Inflammatory status was measured by H&E, CD45 staining and qPCR. Myenteric neurons were examined by immunohistochemistry. Neuromuscular functions and drug efficacy were studied using exogenous agents and electrical field stimulation (EFS) to activate intrinsic nerves. Inflammation was not detected. Numbers of myenteric ganglia/neurons were unchanged (11.7±2.4 vs. 10.3±2.2 neurons/mm myenteric plexus with/without chemoradiotherapy) as were the numbers of cholinergic/nitrergic neurons. EFS stimulated cholinergic and nitrergic neurons so the contractile response of the muscle was the sum of both but dominated by cholinergic (causing contraction) or less often, nitrergic activity (relaxation), followed, after termination of EFS, by neuronally mediated contraction. Inhibition of nitric oxide synthase (by L-NAME 300μM) more clearly defined EFS-evoked contractions. The 5-HT4 agonist prucalopride 10μM and the cholinesterase inhibitor donepezil 1µM, respectively increased and greatly increased the composite contractile response to EFS (measured as 'area-under-the curve') and the contractions isolated by L-NAME (respectively, by 22±14% and 334±87%; n=11/8). After chemoradiotherapy, nitrergic-mediated muscle relaxations occurred more often during EFS (in 29.8±6.1% preparations vs. 12.6±5.1% without chemoradiotherapy, n=21/18). With L-NAME, the ability of prucalopride to facilitate EFS-evoked contraction was lost and that of donepezil approximately halved (contractions increased by 132±36%; n=8). Several months after chemoradiotherapy, the rectum was not inflamed and myenteric neuron numbers/phenotype unchanged. However, nitrergic activity was increased relative to cholinergic activity, and prokinetic-like drug activity was lost or greatly reduced. Thus, chemoradiotherapy causes long-term changes in neuromuscular functions and markedly reduces the efficacy of drugs for treating constipation.

The effect of TCM triple rehabilitation and ear acupoint bean pressing on laparoscopic surgery for gastric cancer.

To explore the clinical value of the triple pre-rehabilitation nursing model in laparoscopic radical surgery for gastric cancer. Eighty-two gastric cancer patients admitted to a certain hospital from May 2020 to May 2023 are included in this study. Patients were divided into control group (CG) and treatment group according to different nursing methods. Comparisons were made by comparing perioperative indicators, immune indicators, sleep quality, nutritional indicators, and anxiety before and after patient care, as well as whether or not to utilize the acupoint patch combined with ear acupoint bean pressing burial in Chinese medicine care. Under the conditions of the triple pre-rehabilitation nursing model, the observation group (OG) patients had their first exhaust time, first bed activity time, first bowel movement time, and hospitalization time of 62.15 ± 5.93, 18.67 ± 7.55, 2.05 ± 0.58, and 7.21 ± 1.05, respectively. The postoperative values of ALB in the CG and OG were 31.59 ± 7.65 and 36.08 ± 8.27, respectively, while the postoperative values of prealbumin were 0.19 ± 0.05 and 0.27 ± 0.09, respectively. The sleep quality of the CG before nursing was 22.57 ± 3.66, and after nursing was 14.36 ± 3.72. The satisfaction rate of the OG was 56.10%, while that of the CG was 46.34%. Patients can better adapt to the treatment process, reduce anxiety, and improve the treatment effect and quality of life after the triple pre-rehabilitation nursing care model and acupoint paste combined with ear acupoint bean pressing burrowing in traditional Chinese medicine nursing.

Impact of COVID-19 on Chronic Ambulatory-Care-Sensitive Condition Emergency Department Use Among Older Adults.

The COVID-19 pandemic social distancing requirements encouraged patients to avoid public spaces including in-office health care visits. Ambulatory-care-sensitive conditions (ACSCs) represent conditions that can be managed with quality primary care and when access is limited, these conditions can lead to avoidable emergency department (ED) visits. Using national data on ED visits from 2019 to 2021 in the National Hospital Ambulatory Care Survey, we examined the impact of COVID-19 pandemic on ACSC ED visits among older adults (aged ≥65). The proportion of ED visits among older adults that were for ACSCs increased between 2019 (17.4%) and 2021 (18.5%). The trend in both rural (26.4%-28.6%) and urban areas (15.4%-16.8%) shows a significant jump from 2019 to 2021 (P < .001). This rise in ACSC ED use is consistent with a delay in normal primary care during the pandemic.