Exploring the relationship between anxiety, patient characteristics and pain outcomes in oral surgery under local anesthesia: The measurement problem.

BACKGROUND: Anxiety during oral surgery can impact patient homeostasis, increase the difficulty of the procedure and create additional stress for the surgeon. Furthermore, it has been associated with more intense and prolonged pain during and after dental treatment. OBJECTIVES: The aim of the study is to evaluate the relationship between anxiety, patient characteristics and pain outcomes in oral surgery, as well as to verify the impact of anxiety on patient's perception of pain during and after oral surgery. MATERIAL AND METHODS: This is a prospective observational study. Several variables were evaluated during the course of the oral surgery. Anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI), Corah's Dental Anxiety Scale (DAS), the Interval Scale of Anxiety Response (ISAR), and Patient SelfRated Anxiety (PAnx) during the procedure. RESULTS: General anxiety measures (STAI) were not associated with specific dental anxiety or external observations of anxiety. Anxiety levels varied according to gender and body mass index (BMI), and were correlated with increased heart rate (HR) (with variability among assessment tools). Odontectomy, ostectomy and an increased volume of anesthesia were associated with higher anxiety levels (with variability among the assessment tools). There was a correlation between pain and anxiety, with anxiety contributing to approx. 12% of the variability in postoperative pain. CONCLUSIONS: Dental anxiety is a complex, multidimensional mental phenomenon characterized by high variability due to the influence of several dynamic factors.

Activin A signaling stimulates neutrophil activation and macrophage migration in pancreatitis.

Acute Pancreatitis (AP) is associated with high mortality and current treatment options are limited to supportive care. We found that blockade of activin A (activin) in mice improves outcomes in two murine models of AP. To test the hypothesis that activin is produced early in response to pancreatitis and is maintained throughout disease progression to stimulate immune cells, we first performed digital spatial profiling (DSP) of human chronic pancreatitis (CP) patient tissue. Then, transwell migration assays using RAW264.7 mouse macrophages and qPCR analysis of "neutrophil-like" HL-60 cells were used for functional correlation. Immunofluorescence and western blots on cerulein-induced pancreatitis samples from pancreatic acinar cell-specific Kras knock-in (Ptf1aCreER™; LSL-KrasG12D) and functional WT Ptf1aCreER™ mouse lines mimicking AP and CP to allow for in vivo confirmation. Our data suggest activin promotes neutrophil and macrophage activation both in situ and in vitro, while pancreatic activin production is increased as early as 1 h in response to pancreatitis and is maintained throughout CP in vivo. Taken together, activin is produced early in response to pancreatitis and is maintained throughout disease progression to promote neutrophil and macrophage activation.

Decreasing polypharmacy in older adults with cancer: A pilot cluster-randomized trial protocol.

INTRODUCTION: Polypharmacy is prevalent in older adults with cancer and associated with multiple adverse outcomes. A single-site, cluster-randomized clinical trial will enroll older adults with cancer and polypharmacy starting chemotherapy and will assess the effectiveness and feasibility of deprescribing interventions by comparing two arms: a pharmacist-led deprescribing intervention and a patient educational brochure. MATERIALS AND METHODS: The study will be conducted in two phases. In phase I, focus groups and semi-structured individual interviews will guide adaptation of deprescribing interventions for the oncology clinic (phase Ia), and eight patients will undergo the pharmacist-led deprescribing intervention with iterative adaptations (phase Ib). In phase II, a pilot cluster-randomized trial (n = 72) will compare a pharmacist-led deprescribing intervention with a patient education brochure, with treating oncologists as the cluster. Both efficacy (relative dose intensity of planned chemotherapy, potentially inappropriate medications successfully deprescribed, chemotherapy toxicity, functional status, hospitalizations, falls, and symptoms) and implementation outcomes (barriers and facilitators) will be assessed. DISCUSSION: This study is anticipated to provide pilot data to inform a nationwide randomized clinical trial of deprescribing in older adults starting cancer treatment. The cluster randomization is intended to provide an initial estimate for the intervention effect as well as oncologists' intra-class correlation coefficient. Deprescribing interventions may improve outcomes in older adults starting cancer treatment, but these interventions are understudied in this population, and it is unknown how best to implement them into oncology practice. The results of this trial will inform the design of large, randomized phase III trials of deprescribing. CLINICALTRIALS: gov Identifier:NCT05046171. Date of registration: September 16, 2021.

Acute Pancreatitis: Current Clinical Approaches, Molecular Pathophysiology, and Potential Therapeutics.

OBJECTIVE: Severe acute pancreatitis (SAP), pancreatic inflammation leading to multiorgan failure, is associated with high morbidity and mortality. There is a critical need to identify novel therapeutic strategies to improve clinical outcomes for SAP patients. MATERIALS AND METHODS: A comprehensive literature review was performed to identify current clinical strategies, known molecular pathophysiology, and potential therapeutic targets for SAP. RESULTS: Current clinical approaches focus on determining which patients will likely develop SAP. However, therapeutic options are limited to supportive care and fluid resuscitation. The application of a novel 5-cytokine panel accurately predicting disease outcomes in SAP suggests that molecular approaches will improve impact of future clinical trials in AP. CONCLUSIONS: Inflammatory outcomes in acute pancreatitis are driven by several unique molecular signals, which compound to promote both local and systemic inflammation. The identification of master cytokine regulators is critical to developing therapeutics, which reduce inflammation through several mechanisms.

Sintomas osteomusculares, absenteísmo e fatores associados em citotecnologistas: estudo transversal / Musculoskeletal complaints, absenteeism and associated factors among cytotechnologists: cross-sectional study

Introdução: Citotecnologistas realizam leitura de lâminas citológicas utilizando o microscópio óptico. Postura estática, velocidade e repetição dos movimentos são fatores que acarretam o aparecimento de sintomas osteomusculares. Objetivos: Identificar os principais sintomas osteomusculares que afetam os citotecnologistas do Instituto Nacional de Câncer (INCA). Estudar possíveis associações entre absenteísmo de citotecnologistas por sintomas osteomusculares e variáveis individuais e profissionais. Caracterizar o absenteísmo por doenças dos citopatologistas do INCA, entre 2016 e 2017, no que tange o grupo de doenças do sistema osteomuscular. Método: Estudo transversal, baseado na aplicação do Questionário Nórdico de Sintomas Osteomusculares. Por meio dos dados do questionário, realizou-se a associação entre as variáveis de exposição e o absenteísmo. Além disso, foram analisados os registros de doenças na Divisão de Saúde do Trabalhador (DISAT) para verificar as principais doenças que resultaram em absenteísmo. As associações foram testadas por meio do Teste de Fisher utilizando o SPSS, versão 20.0, e a significância estatística considerada foi de p<0,05. Resultados: Do total, 34,4% relataram afastamento do trabalho por sintomas osteomusculares. As principais queixas musculoesqueléticas são na coluna cervical (18%). De acordo com os registros da DISAT, os principais motivos de absenteísmo foram por doenças do sistema osteomuscular e do tecido conjuntivo (25%). Observou-se relação estatisticamente significativa entre o tempo de trabalho, Índice de Massa Corporal (IMC) e o absenteísmo por sintomas osteomusculares. Conclusão: As doenças do sistema osteomuscular e do tecido conjuntivo foram os principais motivos de afastamento dos citotecnologistas, existindo associação do absenteísmo com tempo de serviço e IMC elevado.

Background: Cytotechnologists are laboratory professionals who analyze cytology slides under optical microscopes. Static postures, speed and repetitive movements are associated with occurrence of musculoskeletal complaints. Objective: To establish the main musculoskeletal complaints among cytotechnologists at the National Cancer Institute, Brazil, test associations between absenteeism due to musculoskeletal complaints and individual and occupational variables, and characterize absenteeism related to diseases of the musculoskeletal system in 2016 and 2017. Method: Cross-sectional study in which we administered the Nordic Musculoskeletal Questionnaire and tested associations between exposure variables and absenteeism. We also analyzed morbidity records kept at the Occupational Health Division (OHD) to establish the main disorders related to absenteeism. Associations were investigated by means of Fisher's test using SPSS version 20.0. The significance level was set to p<0.05. Results: 34.4% of the sample required sick leave due to musculoskeletal complaints. The most affected body site was the neck (18%). As per the OHD records, sickness absenteeism was mainly due to diseases of the musculoskeletal system and connective tissue (25%). We found statistically significant association of absenteeism with length in the job and body mass index. Conclusion: Diseases of the musculoskeletal system and connective tissue were the main reason for missing work days. Absenteeism was associated with length in the job and high body mass index.