The impact of COVID-19 on analgesic prescribing in an urban emergency department.

BACKGROUND: Providers across the country have significantly decreased opioid prescribing over the past decade to prevent opioid misuse. The COVID-19 pandemic led to a disruption of the healthcare system and changes in the relationships between patients and providers. Consequently, we sought to investigate whether the pandemic had any impact on analgesic prescribing in an urban emergency department. METHODS: This was a retrospective, single center study analyzing pharmacy records of patients that were treated with analgesics between January 2019 and May 2021. The most common analgesics utilized were tallied by month. Utilization of specific analgesics were compared between T1-pre-COVID-19 (1/2019-1/2020) and T2-post-COVID 19 (5/2020-5/2021). Analgesics were also categorized into broader categories (such as IV, oral, opioid, and non-opioid) and compared. Comparisons were analyzed using the t-test, Mann-Whitney u test, or chi-squared difference of proportions tests, as applicable. RESULTS: There were significant decreases in the amount of IV (7.2% vs. 6.5; p = 0.039) and oral opioid (2.6% vs. 2.1%; p = 0.001) administered during COVID-19. There were also decreases in the percent of patients given opioids (T1: 6.7 vs. T2: 4.6, p < 0.001). During COVID, there was an increase in the amount of non-opioid analgesics given per patient (p = 0.013). Particularly, there was an increase in the amount of oral non-opioid administrations per patient (p = 0.005). There was a decrease in utilization of ibuprofen between the two time periods (p < 0.001). CONCLUSIONS: Despite the pandemic, providers continued to decrease opioid prescribing and increase non-opioid prescribing.

A bibliometric and social network analysis perspective of X-ray phase-contrast imaging in medical imaging.

INTRODUCTION: Phase-contrast imaging (PCI) is a novel technology that can visualise variations in X-ray refraction (phase contrast) in addition to differences in X-ray attenuation (absorption contrast). Compared to radiography using conventional methods (i.e. absorption-based imaging), PCI techniques can potentially produce images with higher contrast-to-noise ratio and superior spatial resolution at the same or lower radiation doses. This has led PCI to be explored for implementation in medical imaging. While interest in this research field is increasing, the whole body of PCI research in medical imaging has been under-investigated. This paper provides an overview of PCI literature and then focusses on evaluating its development within the scope of medical imaging. METHODS: Bibliographic data between 1995 and 2018 were used to visualise collaboration networks between countries, institutions and authors. Social network analysis techniques were implemented to measure these networks in terms of centrality and cohesion. These techniques also assisted in the exploration of underlying research paradigms of clinical X-ray PCI investigations. RESULTS: Forty-one countries, 592 institutions and 2073 authors contributed 796 investigations towards clinical PCI research. The most influential contributors and network collaboration characteristics were identified. Italy was the most influential country, with the European Synchrotron Radiation Facility being the most influential institution. At an author level, F. Pfeiffer was found to be the most influential researcher. Among various PCI techniques, grating interferometry was the most investigated, while computed tomography was the most frequently examined modality. CONCLUSIONS: By gaining an understanding of collaborations and trends within clinical X-ray PCI research, the links between existing collaborators were identified, which can aid future collaborations between emerging and established collaborators. Moreover, exploring the paradigm of past investigations can shape future research - well-researched PCI techniques may be studied to bring X-ray PCI closer to clinical implementation, or the potential of seldom-investigated techniques may be explored.

Community Violence, PTSD, Hopelessness, Substance Use, and Perpetuation of Violence in an Urban Environment.

We investigated the relationships among chronic violence exposure, post-traumatic stress disorder (PTSD) symptom severity, hopelessness, substance use, and perpetuation of violence to facilitate the development of trauma-related interventions for residents of Newark, NJ. A convenience sample of Newark residents (N = 153) was recruited from community centers during various events in 2016-2017. Anonymous, self-report survey measures included a PTSD screen (PCL-C), Beck's Hopelessness Scale, the CAGE questionnaire, and a CDC Health Behavior Scale. Descriptive statistics, Pearson's correlations, Chi square analyses, logistic, and linear regressions were used for analysis. Thirty percent (95% CI [22.7, 37.4]) of our sample screened positive for PTSD. Drug and alcohol use, fighting, and hopelessness were related to severity of PTSD symptoms (p < 0.05). Female gender, CAGE scores, and hopelessness predicted the severity of PTSD symptoms (R2 = 0.354, p < 0.05). Our data has informed the development of a resilience support group currently in the pilot stage for community members.

Cinnamon extract inhibits allergen-specific immune responses in human and murine allergy models.

BACKGROUND: Ceylon cinnamon has been shown to possess anti-inflammatory properties in many diseases including allergic inflammation. OBJECTIVE: The aim of this study was to analyse in more detail the effects of cinnamon extract (CE) and its major compounds p-cymene and trans-cinnamaldehyde (CA) on allergen-specific immune responses in vitro and in vivo. METHODS: Therefore, monocyte-derived mature dendritic cells (DC) from grass or birch pollen allergic donors were pulsed with the respective allergen in the presence or absence of CE, p-cymene, CA or the solvent ethanol and co-cultured with autologous CD4+ T cells. Furthermore, basophil activation test was performed with or without CE or ethanol treatment. For the in vivo experiments, BALB/c mice were immunized with ovalbumin (OVA) and orally treated with CE or ethanol. RESULTS: Addition of CE, p-cymene or CA, but not ethanol significantly inhibited DC maturation and subsequent allergen-specific T cell proliferation as well as Th1 and Th2 cytokine production. Sulphidoleukotriene release and CD63 expression by basophils were also significantly diminished after addition of CE. In vivo, treatment of OVA-sensitized mice with CE led to a significant shift from OVA-specific IgE towards IgG2a production and to a strong inhibition of OVA-specific proliferation. Moreover, airway inflammation as well as anaphylaxis after intranasal or systemic allergen challenge was significantly reduced in CE-treated mice. Furthermore, topical application of CE prevented calcipotriol-induced atopic dermatitis-like inflammation in these mice. CONCLUSIONS AND CLINICAL RELEVANCE: Taken together, our data indicate that the anti-inflammatory effect of cinnamon might be exploited for treatment of allergic inflammation, which needs to be further investigated.

Melphalan-flufenamide is cytotoxic and potentiates treatment with chemotherapy and the Src inhibitor dasatinib in urothelial carcinoma.

BACKGROUND: Chemotherapy options in advanced urothelial carcinoma (UC) remain limited. Here we evaluated the peptide-based alkylating agent melphalan-flufenamide (mel-flufen) for UC. METHODS: UC cell lines J82, RT4, TCCsup and 5637 were treated with mel-flufen, alone or combined with cisplatin, gemcitabine, dasatinib or bestatin. Cell viability (MTT assay), intracellular drug accumulation (liquid chromatography) apoptosis induction (apoptotic cell nuclei morphology, western blot analysis of PARP-1/caspase-9 cleavage and Bak/Bax activation) were evaluated. Kinome alterations were characterized by PathScan array and phospho-Src validated by western blotting. Aminopeptidase N (ANPEP) expression was evaluated in UC clinical specimens in relation to patient outcome. RESULTS: In J82, RT4, TCCsup and 5637 UC cells, mel-flufen amplified the intracellular loading of melphalan in part via aminopeptidase N (ANPEP), resulting in increased cytotoxicity compared to melphalan alone. Mel-flufen induced apoptosis seen as activation of Bak/Bax, cleavage of caspase-9/PARP-1 and induction of apoptotic cell nuclei morphology. Combining mel-flufen with cisplatin or gemcitabine in J82 cells resulted in additive cytotoxic effects and for gemcitabine also increased apoptosis induction. Profiling of mel-flufen-induced kinome alterations in J82 cells revealed that mel-flufen alone did not inhibit Src phosphorylation. Accordingly, the Src inhibitor dasatinib sensitized for mel-flufen cytotoxicity. Immunohistochemical analysis of the putative mel-flufen biomarker ANPEP demonstrated prominent expression levels in tumours from 82 of 83 cystectomy patients. Significantly longer median overall survival was found in patients with high ANPEP expression (P = 0.02). CONCLUSION: Mel-flufen alone or in combination with cisplatin, gemcitabine or Src inhibition holds promise as a novel treatment for UC.

Involvement of the rostral anterior cingulate cortex in consolidation of inhibitory avoidance memory: interaction with the basolateral amygdala.

Previous findings suggest that the rostral anterior cingulate cortex (rACC) is involved in memory for emotionally arousing training. There is also extensive evidence that the basolateral amygdala (BLA) modulates the consolidation of emotional arousing training experiences via interactions with other brain regions. The present experiments examined the effects of posttraining intra-rACC infusions of the cholinergic agonist oxotremorine (OXO) on inhibitory avoidance (IA) retention and investigated whether the BLA and rACC interact in enabling OXO effects on memory. In the first experiment, male Sprague-Dawley rats were implanted with bilateral cannulae above the rACC and given immediate posttraining OXO infusions. OXO (0.5 or 3 ng) induced significant enhancement of retention performance on a 48-h test. In the second experiment, unilateral posttraining OXO infusions (0.5, 3.0 or 10 ng) enhanced retention when infused into rACC, but not caudal ACC, consistent with previous evidence that ACC is composed of functionally distinct regions. A third experiment investigated the effects of posttraining intra-rACC OXO infusions (0.5 or 10 ng) in rats with bilateral sham or NMDA-induced lesions of the BLA. The BLA lesions did not impair IA retention, but blocked the enhancement induced by posttraining intra-rACC OXO infusions. Lastly, unilateral NMDA lesions of rACC blocked the enhancement of IA retention induced by posttraining ipsilateral OXO infusions into the BLA. These findings support the hypothesis that the rACC is involved in modulating the storage of emotional events and provide additional evidence that the BLA modulates memory consolidation through interactions with efferent brain regions, including the cortex.