Knowledge of radiation exposure associated with common trauma imaging modalities among orthopaedic surgeons,emergency medicine physicians,and general surgeons in the United States

BACKGROUND:Few contemporary studies have assessed physicians’knowledge of radiation exposure associated with common imaging studies,especially in trauma care.The purpose of this study was to assess the knowledge of physicians involved in caring for trauma patients regarding the effective radiation doses of musculoskeletal(MSK)imaging studies routinely utilized in the trauma setting.METHODS:An electronic survey was distributed to United States orthopaedic surgery,general surgery,and emergency medicine(EM)residency programs.Participants were asked to estimate the radiation dose for common imaging modalities of the pelvis,lumbar spine,and lower extremity,in terms of chest X-ray(CXR)equivalents.Physician estimates were compared to the true effective radiation doses.Additionally,participants were asked to report the frequency of discussing radiation risk with patients.RESULTS:A total of 218 physicians completed the survey;102(46.8%)were EM physicians,88(40.4%)wereorthopaedicsurgeons,and28(12.8%)weregeneralsurgeons.Physicians underestimated the effective radiation doses of nearly all imaging modalities,most notably for pelvic computed tomaography(CT)(median 50 CXR estimation vs.162 CXR actual)and lumbar CT(median 50 CXR estimation vs.638 CXR actual).There was no difference between physician specialties regarding estimation accuracy(P=0.133).Physicians who regularly discussed radiation risks with patients more accurately estimated radiation exposure(P=0.007).CONCLUSION:The knowledge among orthopaedic and general surgeons and EM physicians regarding the radiation exposure associated with common MSK trauma imaging is lacking.Further investigation with larger scale studies is warranted,and additional education in this area may improve care.

The efficacy of tucatinib-based therapeutic approaches for HER2-positive breast cancer

Overexpression of human epidermal growth factor receptor 2 (HER2) occurs in approximately 15–20% of breast cancer cases. HER2 is a member of the epidermal growth factor receptor (EGFR) family with tyrosinase kinase activity, and its overexpression is linked to poor prognosis and shorter progression-free survival (PFS) and overall survival (OS). Among various treatment options, HER2-targeting monoclonal antibodies and tyrosine kinase inhibitors (TKIs) have mostly been applied in recent decades to treat HER2-positive (HER2^(+)) breast cancer patients. Although positive clinical outcomes were documented in both advanced disease and neoadjuvant settings, the development of resistance mechanisms to such approaches has been one of the major challenges with the continuous usage of these drugs. In addition, patients who experience disease progression after treatment with multiple HER2-targeted therapies often have limited treatment options. The Food and Drug Administration (FDA) has recently approved a new TKI (i.e., tucatinib) for use in combination with immunotherapy and/or chemotherapeutic agents for the treatment of advanced-stage/metastatic HER2^(+) breast cancer. This review highlights recent updates on the efficacy of tucatinib-based therapeutic approaches in experimental models as well as in the clinical settings of HER2^(+) breast cancer.

Differential effects of p63 mutants on transactivation of p53 and/or p63 responsive genes

p63，知道在开发起一个作用，更最近也在癌症被含有前进。在 p63 的变化被显示了为几人的发展疾病负责。p63 基因的微分拼接产生 p63 isoforms，它能肿瘤 suppressors 充当或作为 oncogene。在这份报告，我们在 p53/p63 和 p63 的规定上学习了自然地发生的 TAp63 异种的效果特定的目标基因。我们在 p63 异种之中观察了重要差别调整 p53/p63 和 p63 特定的目标基因。另外，我们在 p53/p63 和 p63 感应的 wildtype-p63-mediated 上观察了 p63 异种的微分效果特定的目标基因。我们也证明这些异种差别调整 wildtype p63 的绑定到目标基因的倡导者。而且，房间死亡和幸存上的这些异种的效果与他们当时，调整下游的目标的能力一致与 wildtype TAp63 相比。在摘要，我们的数据证明 p63 异种在 p63 和 p53/p63 上展出微分效果特定的目标基因并且在 apoptosis 的正式就职上，并且提供进一步的卓见进 p63 的函数。

Possible Therapeutic Use of Bumetanide in the Treatment of Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disorder. Autism Spectrum Disorder is diagnosed early on in a child’s life, anywhere from eighteen to twenty-four months. The disorder is characterized by variable degrees, by difficulties in nonverbal communication, verbal communication, social interaction, repetitive behaviors, and movement. The occurrence of ASD has been increasing globally, with the most recent prevalence studies indicating that they are present in six per one thousand children and one in every sixty-eight people of all ages, with a higher incidence among males, with a ratio of four to one. There is no specific target demographic for Autism Spectrum Disorder, nor is there a cure. Over the last few decades, there have been advancements in treating the symptoms associated with Autism Spectrum Disorder. Among the many different fields of research associated with Autism Spectrum Disorder, Bumetanide has shown to be a promising drug therapy for children suffering from Autism, treating specifically the behavioral symptoms associated with ASD. Bumetanide is forty times more potent than furosemide and is a loop diuretic mainly acting in the ascending limb of the loop of Henle. A clinical trial conducted found a decrease in the Childhood Autism Rating Scale (CARS) score, showing improvement in Autism Spectrum Disorder symptoms, such as repetitive behavior and initiating or participating in the social interaction.

Global Impact of Coronavirus Disease 2019 (COVID-19)

The novel coronavirus is a group of viruses with genetic material inside and surrounded by a lipid layer and protein spikes. Coronavirus disease 2019 (COVID-19) is the official name given by the World Health Organization (WHO). SARS-CoV-2 erupted from Wuhan, China, in 2019. By May 2020, COVID-19 was ubiquitous, infected millions of people on this planet, and became the worst outbreak of this disastrous pandemic. The pandemic’s impact such as a high mortality rate and economic imbalance. Random viruses constantly affect humans’ and animals’ health like severe acute respiratory syndrome. SARS COVID 2 followed. However, initially, coronavirus was identified in 2019. COVID-19 affected several sectors: transportation, health care, education, tourism, food sector, unemployment, trading, agriculture, sports, pharmaceutical industries, and global poverty.

The Role of Recruitment and Retention in Clinical Trials

It is evident that both recruitment and retention play critical roles in clinical trials. Recruitment and retention models are beginning to be analyzed worldwide in an effort to assess how to conduct studies more efficiently, all the while, allowing researchers to provide sound and ethical data to help advance medicine through clinical studies. Sponsors and sites have recognized that clinical trial enrollment must become more diverse and inclusive. In this review, we address the important topics of recruitment and retention in clinical trials. Specifically, the obstacles in regard to recruiting vulnerable populations. Methodologies to improve both the understanding of the study population and community engagement are outlined. In particular, newer strategies such as use of social media and more reliable strategies such as trust and relationship building are described in detail. A strong focus on recruitment is becoming widely recognized as being of such importance that consideration is given to this key component even during initial protocol development. Attention to recruitment and retention in the strategic planning process of clinical trials can mitigate enrollment issues that clinical researchers are experiencing.

Tyrosine kinase inhibitors and human epidermal growth factor receptor-2 positive breast cancer

The body of evidence investigating human epidermal growth factor receptor-2(HER2)directed therapy in patients with breast cancer(BC)has been growing within the last decade.Recently,the use of tyrosine kinase inhibitors(TKIs)has been of particular interest in the treatment of human malignancies.This literature commentary is intended to highlight the most recent findings associated with the widely-studied TKI agents and their clinical significance in improving the outcomes of HER2 positive BC.

Hemodynamic investigations in intracranial aneurysms:a commentary

Intracranial aneurysms(IAs)are abnormal bulges in a blood vessel in the brain that have a potential to rupture and even causing a stroke,which can lead to lasting brain damage,long-term disability,or even loss of life.It has been widely acknowledged that hemodynamic factors,e.g.,instantaneous wall shear stress,time-averaged wall shear stress,wall shear stress gradient,gradient oscillatory number,oscillatory shear index,pulsatile blood flow waveform(flow rate magnitude and shape,physical flow period),relative residence time/turnover time,blood pressure.

Cardiovascular Diseases and Radiations

Human beings have continually been exposed to radiation from sources that are terrestrial. There are different sources of radiation for instance ubiquitous background and medical exams that require X-rays. In America for example, the rate of radiation intake per individual increased from 1.6 to 6.2 mSv. The increase has been associated with increased imaging procedures in healthcare facilities. The continued exposure of people to radiant’s increases their rates of developing cardiovascular related diseases. A person who is exposed to low amounts of radiation over a long duration may in the long run develop heart diseases. The result has been obtained from an experiment with the Japanese survivors of the atomic bomb. This research paper focuses on the different sources of radiations and the risk of contracting cardiovascular diseases. The paper also explains the possible relationship between radiations and cardiovascular diseases.

Fractures in Parkinson’s Disease

Parkinson’s disease is a neurodegenerative disorder that is common in older people and is highly associated with depression, anxiety, apathy, psychosis, cognitive impairment, imbalance and sleep disturbances. These patients have an increased risk of fracture compared to the general population. Comprehensive searches of databases are performed to identify reviews about the risk of fractures in this disease. Parkinson’s patients are at increased risk for low bone mineral density due to the effect of drugs, Parkinson’s disease and age factor, leading to an increased risk of falling down and fractures, especially in the hip. So, improved and innovative treatments with the focus on minimizing inadvertent bone resorption with anti-Parkinson’s disease medication will be highly effective in reducing fear of the disease and providing the patient with a better quality of life.

Statins in Alcoholic and Non-Alcoholic Fatty Liver Disease and Chronically Elevated Liver Enzymes

The prevalence of alcoholic liver disease and non-alcoholic liver disease patients has nearly doubled over the past decades worldwide. Alcoholic liver disease among patients with chronic liver disease has increased with arisen due to alcohol consumption and obesity. The diagnosis plays a crucial role in treating such conditions based on the stages of liver functioning. The elevated liver enzymes are the key characterizing of identifying the alcoholic liver disease (ALD) and NAFLD. Later on, there is a progression of the disease conditions by developing fibrosis and cirrhosis, leading to liver carcinoma. The other state, steatohepatitis, is associated with an increase in liver-related and can lead to mortality. Risk factors for both diseases are growing, leading to various complications in health. There is no specific treatment up to date for these conditions, but statins play a crucial role in managing several liver disease conditions. The commonly used drug is hydroxymethylglutaryl coenzyme A (HMG Co-A) reductase inhibitors. It is also known as statins, which help normalize liver enzymes in patients with elevated plasma aminotransferases. As a result, external liver damage is considered safe for the liver as the Statin medication at low to moderate dose usage. OBJECTIVES: The main scope of this review is to study the various factors like pharmacological actions, adverse events, and biochemical and liver cell imaging results in patients with ALD and NAFLD. The different types of statins used in alcoholic and non-alcoholic patients’ clinical data for the safety of the statin therapy were concluded in this review. Fatty liver changes of both liver disease conditions were studied using different drugs. The other liver enzymes like Alanine transaminase (ALT), Aspartate transaminase (AST), Gamma-glutamyl Transferase (GGT), and the effectiveness of Statin therapy are considered vital concepts in this review.

Non-Small Cell Lung Cancer: Treatment, Diagnosis, and Life after Treatment

Lung cancer is becoming the most common cancer globally. In China, Lung cancer has become prevalent among preceding compared to present smokers. There are many treatments for lung cancer globally like Chemotherapy, Radiotherapy, Surgery, and Targeted therapy [1] [2]. Generally, lung cancer starts in the lungs. The spongy lungs in the chest inhale oxygen and exhale carbon dioxide. Those who smoke regularly have the highest risk of lung cancer than nonsmokers. This risk increases with an increase in length, time, and the number of cigarettes smoked. Immediate treatment will help in reducing the severity of cancer. The complications of lung cancer include shortness of breath, coughing up blood, pain, and fluid in the chest. Therefore, the primary step in preventing lung cancer is quitting smoking [3].

Exploiting the relevance of CA 19-9 in pancreatic cancer

Pancreatic ductal adenocarcinoma(PDAC)is currently the fourth most common cause of cancer-related deaths in the United States.It has a poor prognosis and remains a difficulty to treat malignancy.Over the past several decades,significant efforts have been directed towards developing new approaches to enhance the efficacy of therapeutic regimens for PDAC treatment.In recent years,the measurement of serum carbohydrate antigen 19-9(CA 19-9)has become one of the most validated and extensively used tumour biomarkers for PDAC.In particular,serum CA 19-9 levels have been explored as a validated tool to predict either the signs of disease progression or the response to treatment.However,despite its clinical relevance,the implications on diagnosis or accurately predicting tumour resectability,and monitoring disease symptoms in PDAC patients remains limited.This current review highlights the recent updates on the applicability of CA 19-9,its exploitation,and challenges in predicting the treatment efficacy and responses in PDAC patients.

Computational fluid dynamics simulation of intracranial aneurysms-comparing size and shape

Objective:To study the hemodynamics of an anatomic internal carotid artery aneurysm derived from a patient-specific model and then manipulate into two phantom morphologies:one growing uniformly by size and the other changing shape unevenly.Methods:The computational model of the saccular,internal carotid artery,aneurysm was constructed from 3D rotational,digitally subtracted,catheter angiography images.Computational fluid dynamics simulations were performed under pulsatile cardiac flow conditions.Velocity vectors,streamlines,pressure,and wall shear stress(WSS)and its variance distributions were quantitatively visualized.Results:The maximum pressure and WSS from the time-averaged distribution on the inside saccular surface of the original case are 415.38 and 17.61 Pa.In contrast,the bi-lobed shape gives rise to higher peak values of pressure(461.00 Pa)and WSS(33.20 Pa)on the saccular dome.Conversely,the evenly enlarged aneurysm actually results in a slightly lower peak pressure(399.58 Pa)and drastically decreased WSS(9.81 Pa).Conclusions:The current study indicates that the size of the aneurysm should not be the only determining factor for the rupture risk consideration,the irregularity of the aneurysm shape and the corresponding aberrant hemodynamics might be a more important factor to consider for risk assessment.

A Case Report of Methylobacterium radiotolerans Bacteremia and Brain Abscesses

Methylobacterium radiotolerans is a ubiquitous organism found in the environment and is considered an opportunistic pathogen of low virulence in humans.Most human infections from M.radiotolerans have been reported in immunocompromised hosts and have been reported mainly as bloodstream infections related to central venous catheters.We present the first known case of M.radiotolerans as a causative agent of multiple brain abscesses in an immunocompromised host.

Circulating endothelial microvesicles and their carried miR-125a 5p:potential biomarkers for ischaemic stroke

Background Endothelial microvesicles(EMVs)are closely associated with the status of endothelial cells(ECs).Our earlier study has shown that EMVs could exert protective roles in ECs by transferring their carried miR-125a 5p.However,whether circulating EMVs and their carried miR-125a 5p can be used as biomarkers in ischaemic stroke(IS)are remain unknown.Methods We recruited 72 subjects with IS,60 subjects with high stroke risk and 56 age-matched controls.The circulating EMVs and their carried miR-125a 5p(EMV-miR 125a 5p)levels were detected.We used microRNA(miR)array to study expression changes of miRs in plasma EMVs samples of three IS patients and three matched healthy controls.Transient middle cerebral artery occlusion(tMCAO)was used to establish IS mouse model.Results EMVs level was obviously elevated in IS patients,with the highest level in acute stage,and was positively related to carotid plaque,carotid intima-media thickness(IMT),National Institutes of Health Stroke Scale(NIHSS),infarct volume.On the contrary,we observed that EMV-miR 125a 5p level was obviously reduced in IS,with the lowest level in acute stage,and was negatively correlated with carotid plaque,IMT,NIHSS scores,infarct volume.EMVs and EMV-miR 125a 5p levels were closely related with large artery atherosclerosis subgroup.Importantly,EMVs and EMV-miR 125a 5p levels could serve as independent risk factors,and receiver operating characteristic curve achieved an area under curve(AUC)of 0.720 and 0.832 for IS,respectively,and elevated to 0.881 after their combination.In IS mouse model,control EMVs or n-EMVs administration could decrease the infarct volume and neurological deficit score,while increase the cerebral blood flow of IS mice compared with vehicle group,while IS EMVs or oxygen and glucose deprivation(OGD)-EMVs administration aggravated the tMCAO induced ischaemic injury.In addition,we observed that OGD EMVmiR-125a 5p could partially ameliorate the OGD EMVs induced brain injury after IS.Conclusions These findings demonstrate that circulating EMVs and EMV-miR 125a 5p are closely related with the occurrence,progress,subtypes and severity of IS,and they can serve as innovative biomarkers and therapeutic targets for IS,especially when they are combined.