Factors Associated with Acute Kidney Injury Occurrence and Prognosis in Rhabdomyolysis at the Emergency Department.

Background and Objectives: This study aimed to analyze patients with rhabdomyolysis who presented to emergency departments and identify their distribution of related disease and prognostic factors. Materials and Methods: A retrospective cohort study was conducted on patients with rhabdomyolysis who presented to emergency departments over a 10-year period. Patient data, including patients' demographic variables (sex and age), mode of arrival, final diagnosis, statin use, rhabdomyolysis trigger factors, and levels of serum creatine phosphokinase (CPK), myoglobin, creatinine, sodium, potassium, phosphate, calcium, and lactate, were analyzed. Univariate and multivariate logistic regression analyses were conducted to identify the predictive factors of acute kidney injury (AKI). Results: Among the patients, 268 (65.6%) were found to have trigger factors without underlying diseases. Furthermore, 115 (28.2%) patients developed AKI. This comprehensive study sheds light on the diverse factors influencing the occurrence of AKI in rhabdomyolysis and provides insights into AKI predictive markers. Furthermore, we analyzed the cases by dividing them into six groups: occurrence of AKI, occurrence of infection, and simple or complex rhabdomyolysis. CPK time course was found to be important in clinical prognosis, such as AKI occurrence, dialysis or not, and mortality. Conclusions: Age, statin use, elevated creatinine and lactate levels, and initial serum CPK level emerged as significant predictors of AKI. CPK time course was also found to be an important factor in predicting the clinical outcomes of patients with rhabdomyolysis.

CD133-containing microvesicles promote cancer progression by inducing M2-like tumor-associated macrophage polarization in the tumor microenvironment of colorectal cancer.

Tumor-associated macrophages (TAMs) are among the most abundant cell types in the tumor microenvironment (TME). The immunosuppressive TME formed by TAMs is an essential prerequisite for cancer progression. Tumor-derived microvesicles (MVs), a subtype of extracellular vesicle shed directly from the plasma membrane, are important regulators of intercellular communication and TME modulation during tumorigenesis. However, the exact mechanism by which tumor-derived MVs induce the generation of the immunosuppressive TME and polarization of TAMs remains unclear. Here, we investigated the role of CD133-containing MVs derived from colorectal cancer (CRC) cells in macrophage polarization and cancer progression. CD133-containing MVs from CRC cells were incorporated into macrophages, and M0 macrophages were morphologically transformed into M2-like TAMs. CD133-containing MVs were found to increase the mRNA expression of M2 macrophage markers. Additionally, cytokine array analysis revealed that M2-like TAMs induced by CD133-containing MVs increased the secretion of interleukin 6, which activated the STAT3 pathway in CRC cells. Furthermore, the conditioned medium of M2-like TAMs promoted cell motility, epithelial-mesenchymal transition, and cell proliferation. However, MVs from CD133-knockdown cells had little effect on TAM polarization and CRC progression. These results demonstrate that CD133-containing MVs induce M2-like TAM polarization and contribute to cancer progression by mediating crosstalk between tumor cells and TAMs in the TME of CRC.

Analysis of Direct-To-Consumer Healthcare Service Advertisements on Television: An Application of the Patient Expectation Framework.

Direct-to-consumer advertisements for healthcare services constitute a rare channel of public communication where consumers see and hear directly from their local providers and healthcare organizations. Although spending on these advertisements has increased drastically during the past decades, research on their content and effects remains rare. To fill this gap, we analyzed primetime television advertisements for healthcare services directly targeting consumers. The advertisements were collected from the two largest media markets in Nevada for one month. In total, 795 advertisements were identified, and 106 of them were non-duplicates. Analysis revealed that the advertisements focused on patients' good health outcomes by showing them smiling, going out and about, having fun with others, and enjoying rigorous physical activities. On the other hand, the advertisements focused less on the providers. Although the advertisements often showed providers in clinical settings, basic information about their professional degrees was often missing. Mentions of providers' other qualifications and professional experiences were even scarcer. Also, a substantial number of advertisements failed to show providers interacting with patients. Additional analysis of patient and provider characteristics revealed under-representation of racial or ethnic minority and older adult patients. Representation of women and minorities as providers was even more uncommon. We discussed the implications of these findings from the perspective of patient expectation and made suggestions to help providers improve their direct-to-consumer advertisements.

Marijuana Message Channels, Health Knowledge, Law Knowledge, and Confidence in Knowledge as Risk and Protective Factors of Marijuana Use among College Students.

Marijuana use among U.S. college students is the highest since the mid-1980s. Because knowledge about marijuana and confidence in the knowledge are related to changing marijuana laws and marijuana-related messages ubiquitous in college students' information environment, we examined their relationships with use. The Structural Equation Modeling method was used to analyze the relationships using survey responses from 249 college students in an adult-use marijuana legal state. Marijuana health knowledge was related to less use, and law knowledge was related to more use. Both relationships were mediated by perceived risk. Confidence in knowledge was related to more use directly as well as indirectly via lower peer disapproval and lower perceived risk. Among various marijuana message channels, peers were the most influential, contributing to lower health knowledge and higher confidence in knowledge.

Competencies for Health Communication Specialists: Survey of Health Communication Educators and Practitioners.

For more than two decades, health communication educators and practitioners have been working toward establishing a competency model to guide health communication education. This article reports the results of a survey to identify competencies for health communication specialists with master's degrees. To prepare the survey, a working group drafted a competency list through reviewing the literature and soliciting feedback from attendees at a professional society meeting, resulting in lists of items reflecting 18 knowledge domains, 11 skill sets, and 14 application bundles labeled "abilities." The survey asked participants to rate the 43 items in terms of their importance and provide their opinions about the preparation of health communication specialists. The survey was disseminated online through professional associations and completed by 142 participants (74 educators and 68 practitioners). Nearly all of the 43 items were rated "somewhat important" or higher. The lists were reduced to 10 knowledge domains, three skill sets, and five abilities through factor analyses. Replication of the findings and triangulation with studies employing different research methods will help advance this line of inquiry.

US direct-to-consumer medical service advertisements fail to provide adequate information on quality and cost of care.

BACKGROUND: In the 1970s, the Federal Trade Commission declared that allowing medical providers to advertise directly to consumers would be "providing the public with truthful information about the price, quality or other aspects of their service." However, our understanding of the advertising content is highly limited. OBJECTIVE: To assess whether direct-to-consumer medical service advertisements provide relevant information on access, quality and cost of care, a content analysis was conducted. METHOD: Television and online advertisements for medical services directly targeting consumers were collected in two major urban centres in Nevada, USA, identifying 313 television advertisements and 200 non-duplicate online advertisements. RESULTS: Both television and online advertisements reliably conveyed information about the services provided and how to make an appointment. At the same time, less than half of the advertisements featured insurance information and hours of operation and less than a quarter of them contained information regarding the quality and price of care. The claims of quality were substantiated in even fewer advertisements. The scarcity of quality and cost information was more severe in television advertisements. CONCLUSION: There is little evidence that medical service advertising, in its current form, would contribute to lower prices or improved quality of care by providing valuable information to consumers.

U.S. College Students' Marijuana Information Sources, Confidence in Knowledge, and Objective Knowledge.

In recent years, marijuana use on U.S. college campuses reached the highest point while the perceptions of risk and social disapproval registered the lowest since the early 1980s. However, little attention has been paid to the sources of the marijuana-related messages and their relationships with marijuana knowledge and confidence in knowledge, proximate protective/risk factors. To fill this gap, a convenience sample of students (N = 249) on a campus located in a U.S. recreational marijuana legal state were surveyed to identify their marijuana information sources and explore the relationships among the sources, confidence in marijuana knowledge, and objective knowledge. Peers/media were the most important sources and they were used more than other sources. Use of peers/media sources was related to lower health knowledge and higher confidence in knowledge. Although students named parents and education/science sources as important, these were less frequently used than siblings, the sources they named as the least important. This study advanced our understanding of the various sources of marijuana information used by U.S. college students and the relationships between the information sources and confidence in knowledge and objective knowledge, two emerging risk/protective factors in the era of marijuana deregulation.

Content, Exposure, and Effects of Public Discourses about Marijuana: A Systematic Review.

This review presents a comprehensive picture of research studies about marijuana-related content in news, social media, and advertisements. Studies that examined the extent of people's exposure to the messages and its effects were also included. A total of 27 peer-reviewed journal articles and one thesis were located, of which 16 analyzed the content, four contained information about people's exposure to the messages, and ten examined the effects. Over time, news coverage shifted from negative to slightly positive toward marijuana use. Social media and advertisements were overwhelmingly favorable toward marijuana use and legalization by claiming social, romantic, and health benefits of marijuana use while completely downplaying risks. A majority of social media accounts were also run by advocacy groups and industry interests, rather than individuals who were simply sharing opinions or experiences. Furthermore, absence of health authorities among the highly popular social media accounts about marijuana was notable. The news, social media, and advertising messages about marijuana were widely used by the members of public, which in turn generated some demonstrable effects on the audience's marijuana-related perceptions and behaviors. The public and policymakers need to become aware of this information environment for potential marijuana users and take more proactive measures to protect vulnerable populations.

Professionalism and Commercialism on Cosmetic Surgeons' Websites.

This study analyzed the homepages of 250 cosmetic surgeons' websites by focusing on the representation of cosmetic surgery providers, cosmetic surgery recipients, and cosmetic surgery practice itself. Based on a literature review, some common elements of the webpages were preidentified as the indicators of professionalism or commercialism. Subsequently, each homepage was scrutinized for their presence and salience. Overall, cosmetic surgeons' websites were high in professionalism and low in commercialism in their representation of the service providers. In depicting the recipients, the websites were moderate in both professionalism and commercialism. The representation of practice was low in professionalism and moderate in commercialism. Implications of these findings for doctors, regulators, and consumer advocates are discussed and directions for future research are proposed.

Extended Monopole antenna Array with individual Shield (EMAS) coil: An improved monopole antenna design for brain imaging at 7 tesla MRI.

PURPOSE: To propose a new Extended Monopole antenna Array with individual Shields (EMAS) coil that improves the B1 field coverage and uniformity along the z-direction. METHODS: To increase the spatial coverage of Monopole antenna Array (MA) coil, each monopole antenna was shielded and extended in length. Performance of this new coil, which is referred to as EMAS coil, was compared with the original MA coil and an Extended Monopole antenna Array coil with no shield (EMA). For comparison, flip angle, signal-to-noise ratio (SNR), and receive sensitivity maps were measured at multiple regions of interest (ROIs) in the brain. RESULTS: The EMAS coil demonstrated substantially larger flip angle and receive sensitivity than the MA and EMA coils in the inferior aspect of the brain. In the brainstem ROI, for example, the flip angle in the EMAS coil was increased by 45.5% (or 60.0%) and the receive sensitivity was increased by 26.9% (or 14.9%), resulting in an SNR gain of 84.8% (or 76.3%) when compared with the MA coil (or EMA). CONCLUSION: The EMAS coil provided 25.7% (or 24.4%) more uniform B1+ field distribution compared with the MA (or EMA) coil in sagittal. The EMAS coil successfully extended the imaging volume in lower part of the brain. Magn Reson Med 75:2566-2572, 2016. © 2015 Wiley Periodicals, Inc.

"Let's Get This Party Started!": An Analysis of Health Risk Behavior on MTV Reality Television Shows.

Past research has examined portrayals of risk behavior in various media, including television, advertising, and film. To address an underexplored area, this study analyzed drinking, smoking, and sexual activities in MTV reality programming popular among adolescent viewers from 2004 to 2011. Cast members' demographic attributes were also examined in relation to their risk behaviors. Results demonstrated that drinking and casual sexual behaviors were pervasive among cast members. Smoking and more intense sexual behaviors were also present, but to a smaller degree. Men and young adult cast members were more likely to engage in risk behaviors than women and teenage cast members. Also, ethnic/racial minority characters were shown drinking more often than were White cast members. Interpretations of these findings are discussed based in social cognitive theory and the concept of super peers. Implications for future research are provided.

Perinatal clinical course of Vici syndrome associated with novel EPG5 variants: unique cardiac changes and difficulty with foetal diagnosis.

Vici syndrome is a genetic disorder involving autophagy dysfunction caused by biallelic pathogenic variants in ectopic P-granules 5 autophagy tethering factor (EPG5). We report the perinatal clinical course of a neonate with Vici syndrome with a unique cardiac presentation. Foetal ultrasonography (US) detected right ventricular hypertrophy, hypoplastic left ventricle and narrowing of the foramen ovale, which were alleviated after birth. Agenesis of the corpus callosum and cerebellar hypoplasia were missed antenatally. After delivery, the patient was clinically diagnosed with Vici syndrome and two novel pathogenic mutations were detected in EPG5 The T-cell receptor repertoire was selectively skewed in the Vß2 family. Immunological prophylaxis and tube feeding were introduced. Early diagnosis helps parents accept their child's prognosis and decide on a care plan. However, US has limited potential to detect clinical phenotypes associated with Vici syndrome. Foetal MRI may detect the characteristic abnormalities and contribute to antenatal diagnosis.

CD133-containing microvesicles promote colorectal cancer progression by inducing tumor angiogenesis.

Angiogenesis is an indispensable mechanism in cancer progression, as cancer cells need to establish blood vessels to supply oxygen and nutrients. Extracellular vesicles (EVs) derived from cancer cells act as messengers in the tumor microenvironment and induce resistance to anti-angiogenic cancer treatment. EVs can be classified into two categories: exosomes and microvesicles (MVs). Although exosomes are involved in angiogenesis, the role of MVs in angiogenesis and cancer progression remains unclear. CD133 plays a key role in MV formation and oncoprotein trafficking. In this study, we investigated the role of CD133-containing MVs derived from colorectal cancer (CRC) in angiogenesis and cancer progression. CRC-derived MVs were incorporated into endothelial cells and increased the mesh area and tube length of endothelial cells. CD133-containing MVs also stimulate vessel sprouting in endothelial cell spheroids and mouse thoracic aortas. However, MVs derived from CD133-knockdown CRC cells exerted a limited effect on tube formation and vessel sprouting. CD133-containing MVs induced angiogenesis through p38 activation and angiogenesis induced by CD133-containing MVs was insensitive to the anti-vascular endothelial growth factor antibody bevacizumab. Survival analysis revealed that high expression level of CD133 correlated with poor prognosis in patients with metastatic CRC. These findings suggest that CD133-containing MVs act as key regulators of angiogenesis and are related to the prognosis of CRC patients.

Morphologic and genomic changes of thyroid cancer cell lines exposed to conditions of simulated microgravity.

Microgravity in space impacts human health. In particular, thyroid cancer, which has a high incidence rate, has been the subject of numerous studies with respect to microgravity. However, most studies have focused on Western follicular thyroid cancer cell lines, while data regarding the effects of microgravity on Asian cell lines are lacking. Therefore, we aimed to investigate the effect of simulated ground-based microgravity on two Korean thyroid cancer cell lines, namely SNU-790 and SNU-80. We found that both cell lines formed multicellular spheroids under simulated microgravity. Gene expression analysis revealed that in SNU-790 cells, histone-related genes were upregulated and microRNA-related genes were downregulated. Meanwhile, in SNU-80 cells, genes related to the cellular response to hypoxia were downregulated. These findings contribute to a better understanding of the effects of microgravity on thyroid cancer cells. Further validation studies and clinical significance analyses are needed to fully understand the implications of these findings.

Super-resolution track-density imaging of thalamic substructures: comparison with high-resolution anatomical magnetic resonance imaging at 7.0T.

The thalamus is one of the most important brain structures, with strong connections between subcortical and cortical areas of the brain. Most of the incoming information to the cortex passes through the thalamus. Accurate identification of substructures of the thalamus is therefore of great importance for the understanding of human brain connectivity. Direct visualization of thalamic substructures, however, is not easily achieved with currently available magnetic resonance imaging (MRI), including ultra-high field MRI such as 7.0T, mainly due to the limited contrast between the relevant structures. Recently, improvements in ultra-high field 7.0T MRI have opened the possibility of observing thalamic substructures by well-adjusted high-resolution T1 -weighted imaging. Moreover, the recently developed super-resolution track-density imaging (TDI) technique, based on results from whole-brain fiber-tracking, produces images with sub-millimeter resolution. These two methods enable us to show markedly improved anatomical detail of the substructures of the thalamus, including their detailed locations and directionality. In this study, we demonstrate the role of TDI for the visualization of the substructures of the thalamic nuclei, and relate these images to T1-weighted imaging at 7.0T MRI.

Seven-Tesla magnetic resonance images of the substantia nigra in Parkinson disease.

OBJECTIVE: To investigate anatomical changes in the substantia nigra (SN) of Parkinson disease (PD) patients with age-matched controls by using ultra-high field magnetic resonance imaging (MRI). METHODS: We performed 7T MRI in 10 PD and 10 age-matched control subjects. Magnetic resonance images of the SN were obtained from a 3-dimensional (3D) T(2)*-weighted gradient echo sequence. Region of interest-based 3D shape analysis was performed to quantitatively compare images from the 2 groups. RESULTS: The boundary between the SN and crus cerebri was not smooth in PD subjects. Undulation in the lateral surface of the SN appeared more intense in the side contralateral to that with the more severe symptoms, and more prominent at the rostral level of the SN than at the intermediate or caudal levels. In addition to the lateral surface, there was a striking difference in the dorsomedial aspects of the SN between PD and control subjects. In control subjects, a brighter signal region was observed along the dorsomedial surface of the lateral portion of SN, whereas in PD subjects, this region was observed as a dark region containing a hypointense signal in T(2)*-weighted images. The measurement of SN volumes, normalized to the intracranial volumes, showed higher values in PD subjects than in control subjects. INTERPRETATION: This study demonstrates that 3D 7T MRI can definitively visualize anatomical alterations occurring in the SN of PD subjects. Further pathological studies are required to elucidate the nature of these anatomical alterations.

Social media intervention for promoting breastfeeding among WIC participants.

Social media have emerged as a promising communication channel for promoting breastfeeding among a new generation of mothers. Yet, there is no published study reporting the effects of a large-scale social media intervention on key breastfeeding-related perceptions, attitudes, and behaviors. As a component of its breastfeeding promotion campaign, the Women, Infants, and Children (WIC) program implemented a 12-month intervention using Facebook and Instagram and subsequently evaluated the outcomes by surveying WIC-participating women (N = 832) twice, immediately before and after the intervention. Based on their level of exposure to the intervention messages, the women were retrospectively classified into two groups, resulting in a two-group (no-low exposure vs. medium-high exposure) quasi-experiment. Women in the medium-high exposure group, in comparison with women in the no-low exposure group, exhibited higher campaign awareness (p < .001), visits to the campaign website (p < .001), and engagement with the website content (p < .001). They also reported more positive breastfeeding attitudes (M = 17.26 vs. M = 16.51, p < .05), self-efficacy (M = 54.48 vs. M = 49.94, p < .01), and social support (M = 27.37 vs. M = 25.11, p < .001). But they did not differ from women in the no-low exposure group in breastfeeding initiation (p > .05) and duration (p > .05). In conclusion, a social media-based intervention resulted in more positive breastfeeding attitudes, higher self-efficacy, and higher perceived social support. Future studies need to investigate the optimal level of intervention message dosage that prompts significant behavioral changes.

Gender differences in the risk and protective factors of marijuana use among U.S. College students.

Gender differences in the risk and protective factors of marijuana use among college students were explored by analyzing online survey responses from 464 undergraduates. Women perceived higher risk and used marijuana less than men, with no gender difference in peer disapproval. In addition, women had higher objective knowledge regarding the health effects of marijuana, although they exhibited lower confidence in their knowledge. In subsequent regression analyses, health knowledge, confidence in knowledge, perceived risk, and peer disapproval predicted women's marijuana use, whereas only confidence in knowledge and perceived risk predicted men's use. These findings can help devise effective intervention strategies.

Marijuana knowledge, confidence in knowledge, and information efficacy as the protective and risk factors of marijuana use among college students.

Objective This study explored the relationships between marijuana knowledge, confidence in knowledge, and information efficacy and marijuana use. Furthermore, the effects of the knowledge-related variables were examined on intention to use, resistance efficacy, and intention to vote for legalization. Participants: Undergraduate students (N = 215) were surveyed in Fall 2018. Methods: Data were collected online and analyzed through a series of regression analyses. Results: Higher knowledge was related to less use via higher perceived risk whereas higher confidence in knowledge was related to more use. Marijuana use was related to higher future intention to use, lower resistance self-efficacy, and intention to vote for legalization. Information efficacy was related to intention to vote for legalization only. Conclusions: Students with more knowledge were less likely to use marijuana, whereas students who considered themselves well-informed were more likely to use it. Future intervention efforts will benefit from counteracting students' misplaced confidence in their knowledge.