Cost Implications of Using Carbetocin Injection to Prevent Postpartum Hemorrhage in a Canadian Urban Hospital.

OBJECTIVE: Recent World Health Organization (WHO) recommendations regarding uterotonics for the prevention of postpartum hemorrhage (PPH) state that carbetocin should be considered a first-line prophylactic agent for all births where its cost is comparable to other effective uterotonics. This study evaluated whether a room temperature stable formulation of carbetocin met this recommendation in a Canadian urban hospital setting. METHODS: A decision tree model was developed to assess the financial implications of replacing oxytocin with carbetocin as a first-line prophylactic agent for PPH prevention in a Greater Toronto Area (GTA) hospital. The analysis accounted for the mode of delivery, efficacies of carbetocin and oxytocin in PPH prevention, occurrence of PPH-related health outcomes, and health care resource costs for PPH interventions. RESULTS: This study found that a GTA hospital, with 3242 deliveries per year, could save over CAD $349 000 annually by switching to room temperature stable carbetocin for PPH prevention. Carbetocin was able to lower institution costs by reducing the use of health care resources for PPH management in low-risk and high-risk PPH patients. The cost-saving potential of carbetocin relative to oxytocin was largely attributed to its greater efficacy in preventing the consequences of PPH. CONCLUSION: The use of room temperature stable carbetocin as a first-line prophylactic agent for PPH prevention meets WHO recommendations regarding uterotonics for PPH in a GTA hospital. The model from this study can be used to determine the financial impact of switching from oxytocin to carbetocin in other jurisdictions while diversifying a hospital's pool of PPH prophylactic agents.

Aeromedical Implications of Long-Term COVID-19 Sequelae.

BACKGROUND: While many COVID-19 studies focus on acute effects of the infection, few examine the intermediate and long-term sequelae of the illness. Studies have shown that a good portion of patients have chronic effects in several body systems for several months or longer. Such effects can potentially adversely impact pilot performance in flight. We sought to determine the long-term effects of COVID-19 infection, how such effects can affect pilot performance, and how to best evaluate pilots for aeromedical flight clearance.METHODS: We used the PubMed literature search engine to review peer-reviewed articles that focused on the intermediate and long-term effects of COVID-19 infection. Chronic signs and symptoms were subdivided based on the particular body organ system affected. Merging information obtained from case reviews, article reviews, and aeromedical standards, we created a risk stratification guide to assist with the aeromedical disposition of affected pilots.RESULTS: Long-term effects of COVID-19 infection can last for several months or longer. The most common effects are fatigue, weakness, pulmonary diffusion defects, depression, and anxiety.DISCUSSION: This review article focuses on the most common intermediate- and long-term COVID-19 conditions of aeromedical significance and the corresponding course of actions recommended for the aeromedical examiner. Aeromedical evaluation should take into consideration factors related to the pilot, aircraft type, and specific aviation environment. Such evaluation may include diagnostic testing, medical specialist consultation, preflight simulation in an altitude chamber, human centrifuge testing, and/or a flight simulator checkride.Ko SY, Nguyen NK, Lee CL, Lee LA, Nguyen KUT, Lee EC. Aeromedical implications of long-term COVID-19 sequelae. Aerosp Med Hum Perform. 2021; 92(11):898-907.

Multiple E-2D Hawkeye Aircrew with Neurocognitive Symptoms During a Single Over-Pressurization Episode.

BACKGROUND: Increased frequencies of physiological episodes have been a significant concern for Naval Aviation for the last several years. These include several aircraft platforms, but no previously documented E-2D Hawkeye events. This report documents an episode in an E-2D, with multiple aircrew affected at the same time.CASE REPORT: While deployed aboard a U.S. aircraft carrier, five E-2D Hawkeyes aircrew were simultaneously exposed to the same over-pressurization during a routine sortie. Out of the five aircrew, four immediately reported hypoxic-like neurocognitive symptoms of mental slowing, difficulty concentrating, and headache. They were evaluated and treated using standard protocol according to the Physiologic Event Clinical Practice Guidelines set by the Naval Safety Center. All aircrew were treated with 100% ground level oxygen with resolution of symptoms.DISCUSSION: Although rare, physiological events may occur in multipassenger platforms such as the E-2D Hawkeye. Utilizing and strictly adhering to standard clinical practice guidelines provided an efficient process of evaluation by different flight surgeons concurrently that avoided a possible delay in treatment. After, eliminating other potential etiology for the crews symptoms, a pressure-related mechanism of injury appears to be the most probable cause.Ko SY, Rice GM. Multiple E-2D Hawkeye aircrew with neurocognitive symptoms during a single over-pressurization episode. Aerosp Med Hum Perform. 2020; 91(12):970974.

Racial discrimination, ethnic-racial socialization, and cultural identities among Asian American youths.

OBJECTIVES: This study investigates whether and how racial discrimination is associated with ethnic-racial socialization in the family and how distinct aspects of ethnic-racial socialization influence children's ethnic and American identity among Filipino American and Korean American families. METHOD: The data are obtained from the Midwest Longitudinal Study of Asian American Families Project (N = 1,580; 379 Filipino American youths and 377 parents, and 410 Korean American youths and 414 parents; Mage of youths = 15.01). Using the bootstrapping and maximum likelihood with missing values approaches, we conducted path analyses to test the hypothesized associations concurrently and longitudinally for each ethnic group. RESULTS: Youth-reported racial discrimination was directly associated with weaker American identity, both concurrently and longitudinally. In concurrent models, racial discrimination experienced by both youth and parents was positively associated with youth-reported preparation for bias, which in turn was linked with stronger ethnic identity among Filipinos, whereas no indirect pathways reached statistical significance among Koreans. In longitudinal models, parent-reported discrimination was linked with higher levels of promotion of mistrust among both groups, which predicted weaker ethnic identity among Filipino youth but stronger American identity among Korean youth. CONCLUSIONS: The present study highlights how exposure to racial discrimination may have a lasting influence in cultural identity development among Asian Americans and possibly through ethnic-racial socialization in the family, which might have been shaped by such experiences. Our results also underscore the importance of considering the experiences of both children and parents in studies of discrimination and ethnic-racial socialization. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

CDX2 co-localizes with liver-intestine cadherin in intestinal metaplasia and adenocarcinoma of the stomach.

CDX2 and liver-intestine (LI)-cadherin are intestine-specific markers and both are physiologically expressed in the small intestine and colon. Recent studies have demonstrated that CDX2 regulates LI-cadherin gene (CDH17) expression in colorectal cancer. The present study investigated the relationship of CDX2 and LI-cadherin expression in gastric cancer. One hundred and nine pairs of tumour and non-cancerous gastric mucosa were collected from gastrectomy specimens. Protein expression levels of CDX2 and LI-cadherin were determined by immunohistochemical staining. Semi-quantitative RT-PCR showed that the mRNAs of both CDX2 and CDH17 were highly expressed in tumour compared with non-cancerous mucosa. Overexpression of CDX2 was significantly associated with CDH17 in gastric adenocarcinoma. Furthermore, the expression of CDX2 and LI-cadherin proteins was strongly coupled in intestinal metaplasia. In conclusion, overexpression of CDH17 is significantly associated with CDX2.

Overexpression of LI-cadherin in gastric cancer is associated with lymph node metastasis.

Gastric cancer remains the second leading cause of cancer deaths worldwide. Patients usually present late with local invasion or metastatic diseases. The present study investigated the expression level of liver-intestine cadherin (LI-cadherin) by RT-PCR and its correlation with clinicopathological data in 71 pairs of tumor and non-cancerous gastric mucosa. Protein expression level of LI-cadherin was determined by Western blotting and immunohistochemistry. The mRNA of LI-cadherin was highly expressed in tumor as compared to non-cancerous mucosa. Lymph node metastasis was significantly associated with the expression of LI-cadherin (p=0.038). On multivariate analysis, T staging and LI-cadherin expression were found to be independent factors associated with lymph node metastasis.

Definitions of "respiratory depression" with intrathecal morphine postoperative analgesia: a review of the literature.

PURPOSE: To review the postoperative intrathecal morphine (ITM) analgesia literature for their definitions of "respiratory depression" (RD). SOURCE: Medline (1966 - June Week 5 2001) and reference lists were searched for original studies involving bolus-dose ITM for postoperative analgesia, which used "respiratory depression" or similar terms. PRINCIPLE FINDINGS: The search identified 209 studies. These were included if ITM use was appropriate (bolus dose, postoperative analgesia) and the term "respiratory depression" was used, which left 96 studies remaining. Forty-four (46%) did not define "RD" despite using this term. A further 24 (25%) defined RD with respiratory rate (RR) alone. Only 28 (29%) defined RD with more than RR alone. There was no statistically significant association between the presence of a definition for RD with study design, study size or publication period. Also, no significant association existed between rigorousness of RD definitions and the above factors. CONCLUSION: The term "respiratory depression" has no clear definition from a review of the literature on ITM use for postoperative analgesia. While defining RD with bradypnea is superior to having no definition, this is still inadequate. In future research, the consistent use of terms with specific meanings will facilitate understanding the true incidence of ITM's respiratory effects. If "respiratory depression" is used, then an explicit definition of its meaning should be provided. Future research must also address what is clinically significant respiratory impairment from intrathecal opioids, and how to optimally monitor for this. Further delineating their risks vs benefits will allow for more optimal dosing.

Soluble E-cadherin is an independent pretherapeutic factor for long-term survival in gastric cancer.

PURPOSE: To evaluate whether pretherapeutic serum soluble E-cadherin is an independent factor predicting long-term survival in gastric cancer. Gastric cancer remains the second leading cause of cancer-related deaths in the world, but a satisfactory tumor marker is currently unavailable for gastric cancer. Soluble E-cadherin has recently been found to have prognostic value in gastric cancer. PATIENTS AND METHODS: One hundred sixteen patients with histologically proven gastric adenocarcinoma were included in the trial. Pretherapeutic serum was collected, and soluble E-cadherin was assayed using a commercially available enzyme-linked immunosorbent assay kit. The patients were followed up prospectively at the outpatient clinic. RESULTS: There were 75 men and 41 women, with a mean (+/- SD) age of 66 +/- 14 years. Forty-eight percent of tumors were located in the gastric antrum. The median survival time was 11 months. The mean pretherapeutic value of soluble E-cadherin was 9,159 ng/mL (range, 6,002 to 10,025 ng/mL), and the mean pretherapeutic level of carcinoembryonic antigen was 11 ng/mL (range, 0.3 to 4,895 ng/mL). On multivariate analysis, soluble E-cadherin is an independent factor predicting long-term survival. Ninety percent of patients with a serum level of E-cadherin greater than 10,000 ng/mL had a survival time of less than 3 years (P =.009). CONCLUSION: Soluble E-cadherin is a potentially valuable pretherapeutic prognostic factor in patients with gastric cancer.