Resource utilization and convalescent care cost in neonatal opioid withdrawal syndrome

BACKGROUND: Neonatal opioid withdrawal syndrome (NOWS) is a growing public health problem associated with complex and prolonged medical care and a significant resource utilization burden. The objective of this study was to compare the cost of different convalescent care settings for infants with NOWS. METHODS: Retrospective comparison study of infants with NOWS discharged directly from NICU, transferred to an acute care pediatric floor (PPCU) or rehabilitation hospital (PRH). Primary outcomes were length of stay (LOS) and cost of stay (COS). RESULTS: Infants had 1.3 (95% CI: 1.1,1.6) times and 2.5 (95% CI: 2.1,3.1) times significantly longer mean LOS for PPCU and RH discharges compared to NICU discharges. NICU discharged infants had the lowest mean COS ($25,745.00) and PRH the highest ($60,528.00), despite PRH having a lower cost per day. PRH discharged infants had higher rates of methadone and benzodiazepine and less buprenorphine exposure than NICU/PPCU discharged. Infants born to mothers on marijuana and buprenorphine had a 28% lower mean COS compared to unexposed infants. Median treatment cumulative morphine doses were six-fold higher for PRH than NICU discharge. CONCLUSIONS: Infants transferred to convalescence care facilities had longer and more costly admissions and received more medication. However, there may be a role for earlier transfer of a subset of infants at-risk for longer LOS as those exposed to methadone and/or benzodiazepines. Further studies exploring differences in resource utilization, convalescent care delivery and cost expenditure are recommended.

Practice patterns of pediatric total body irradiation techniques: A Children's Oncology Group survey

PURPOSE

The aim of this study was to examine current practice patterns in pediatric total body irradiation (TBI) techniques among xxx member institutions.

METHODS AND MATERIALS

Between Nov 2019 and Feb 2020 a questionnaire, containing 52 questions related to the technical aspects of TBI was sent to medical physicists at 152 xxx institutions. The questions were designed to obtain technical information on commonly used TBI treatment techniques. Another set of 9 questions related to the clinical management of patients undergoing TBI was sent to 152 xxx member radiation oncologists at the same institutions.

RESULTS

Twelve institutions were excluded because TBI was not performed in their institutions. A total of 88 physicists from 88 institutions (63% response rate) and 96 radiation oncologists from 96 institutions responded (69% response rate). The AP/PA technique was the most common (49 institutions - 56%); 44 institutions (50%) used the lateral technique and 14 institutions (16%) used volumetric modulated arc therapy (VMAT)/Tomotherapy. Mid-plane dose rates of 6-15 cGy/min were most commonly used. The most common specification for lung dose was the mid lung dose for both AP/PA (71%) and lateral (63%) techniques. All physician responders agreed with the need to refine current TBI techniques and 79% supported the investigation of new TBI techniques to further lower the lung dose.

CONCLUSION

There is no consistency in the practice patterns, methods for dose measurement and reporting of TBI doses among xxx institutions. The lack of a standardization precludes meaningful correlation between TBI doses and clinical outcomes including disease control and normal tissue toxicity. The xxx radiation oncology discipline is currently undertaking several steps to standardize the practice and dose reporting of pediatric TBI using detailed questionnaires and phantom-based credentialing for all xxx centers.

Ethyl 2-cyano-2-{(Z)-2-[2,2-dicyano-1-(4-methylphenyl)ethyl]cyclohexylidene}acetate

In the crystal of the title cyclo­hexyl­idene derivative, mol­ecules associate via C—H⋯N hydrogen bonds, forming a three-dimensional network.

In the title compound, C₂₂H₂₃N₃O₂, the cyclo­hexane ring adopts a chair conformation. The methyl­phenyl ring is oriented at an angle of 36.2 (1)° with respect to the best plane of cyclo­hexane moiety. In the crystal, mol­ecules associate via C—H⋯N hydrogen bonds, forming a three-dimensional network.

Model-based evaluation of the efficacy and safety of nivolumab once every 4 weeks across multiple tumor types

BACKGROUND

Nivolumab 480 mg every 4 weeks (Q4W) is approved in the European Union, United States, and several other markets across multiple tumor types. Its approval was supported by quantitative efficacy/safety analyses bridging to 3 mg/kg every 2 weeks (Q2W).

PATIENTS AND METHODS

The benefit-risk profile of nivolumab 480 mg Q4W relative to 3 mg/kg Q2W was evaluated using population pharmacokinetic modeling and exposure-response (E-R) analyses for safety and efficacy. Pharmacokinetic exposures were predicted for 3203 patients with melanoma, non-small-cell lung cancer (NSCLC), renal cell carcinoma (RCC), squamous cell carcinoma of the head and neck, urothelial carcinoma, or classical Hodgkin lymphoma. Quantitative models analyzed E-R to predict 480-mg Q4W safety across all indications and efficacy for melanoma, NSCLC, and RCC. Intratumoral receptor occupancy (RO) was predicted for parameters representing different tumor types.

RESULTS

Time-averaged concentrations for 480 mg Q4W versus 3 mg/kg Q2W were higher during the first 28 days (26.8%) and similar at steady state (5.2%). The maximum concentration (C_max) after the first dose was higher (110.4%), and the trough concentration at day 28 was lower (-22.1%) with 480 mg Q4W versus 3 mg/kg Q2W. The C_max achieved with 480 mg Q4W was lower than the previously established safe dose of 10 mg/kg Q2W. The probability of adverse events for key safety end points was similar for 480 mg Q4W and 3 mg/kg Q2W. The predicted overall survival and objective response rates with 480 mg Q4W were comparable to 3 mg/kg Q2W. The predicted high intratumoral RO provided additional evidence to support 480 mg Q4W across tumor types.

CONCLUSIONS

The benefit-risk profile for nivolumab 480 mg Q4W was predicted to be similar to that of 3 mg/kg Q2W across tumor types while providing a convenient and flexible option for patients and their caregivers.

Kinetics and mechanism of the oxidation of alkenes by chromium(VI) in the presence of complexing agents

The catalytic activities of 2,2′-bipyridyl (bipy) and oxalic acid (Oxa) in the HCrO4– oxidation of some substituted trans-cinnamic acids have been investigated in acidic solutions. The Cr(VI)–bipy and Cr(VI)–Oxa complexes are believed to be the probable reactive electrophiles in this redox process. The kinetic data reveal that electron-releasing groups enhance the reactivity to a significant extent while the electron-withdrawing ones reduce the rate marginally. It appears that the mechanism of bipy/Oxa catalysed chromium(VI) oxidation of unsaturated systems to the corresponding cleavage products involves an electrophilic attack of the reactive complex at the C–C double bond. The formation of a ternary complex as an intermediate is envisaged to describe the redox process. In this paper, we also report on the kinetic form of the oxidation of trans-stilbene to methyl 3-hydroxy-2,3-diphenylpropanoate. The mechanistic pathway has been determined based on the kinetic behaviour and the product assignment.

Conversion of Piperidine-4-ones into [1,4]-diazepan-5-ones under Microwave Irradiation Using a Silica Gel Supported NaHSO4 Catalyst

A rapid conversion of some 2,6-diarylpiperidin-4-ones into 2,7-diaryl-[1,4]-diazepan-5-ones in high yields has been developed involving treatment with hydroxylamine hydrochloride under microwave irradiation in the presence of a silica gel supported NaHSO4 catalyst.

Exploring circulatory shock and mortality in viper envenomation: a prospective observational study from India

BACKGROUND

Viper envenomation contributes to nearly 50% of snake-bite deaths in India, chiefly due to circulatory shock. The mechanisms leading to circulatory shock include bleeding, capillary leak syndrome (CLS) and myocardial depression. Pituitary-adrenal axis involvement in circulatory shock, though described, has not been fully elucidated.

AIM

To identify predictors of circulatory shock and mortality in viper envenomation and explore the role of pituitary-adrenal axis in circulatory shock.

DESIGN

Prospective hospital-based observational study.

METHODS

Once a syndromic diagnosis of viper envenomation was made, relevant clinical and laboratory data were collected. Serum cortisol was estimated in those with circulatory shock. Post-mortem examination of pituitary, kidneys and adrenals was performed. Adjusted odds-ratios were calculated for respective risk-factors for shock and mortality using multivariable logistic regression with backward elimination strategy.

RESULTS

Of 248 patients of viper envenomation treated at our hospital, circulatory shock was present in 19% and in-hospital mortality was 23%. CLS, circulatory shock, bleeding and requirement of > 20 vials of antivenom predicted mortality. Ischaemic and haemorrhagic necrosis of pituitary or adrenals was present in 51% of post-mortem specimens. Disseminated intravascular coagulation (DIC) and CLS were strong predictors of pituitary haemorrhage.

CONCLUSION

Predictors of mortality - bleeding, CLS and requirement of high antivenom doses are warning signs which can alert clinicians to patients who may have poor outcomes. Our study points to a definite role of pituitary-adrenal axis in circulatory shock supports the hypothesis that pituitary involvement in viper envenomation closely resembles Sheehan syndrome. The mechanism of pituitary involvement appears to be a result of increased susceptibility of the swollen gland secondary to CLS and micro thrombi deposition in DIC.

Acute hypopituitarism complicating Russell's viper envenomation: case series and systematic review

BACKGROUND

Chronic hypopituitarism following Russell viper envenomation (RVE) is a rare but well-recognized syndrome. The clinical features, associations, management and outcomes of RVE associated-acute hypopituitarism (AHP) are not well described.

AIMS

To describe the clinical features, intensive care unit (ICU) management and outcomes of a series of patients with RVE-AHP and identify the clinical associations of RVE-AHP.

METHODS

We describe a series of patients with prospectively identified AHP related to RVE and describe our findings comparing RVE with and without AHP and a systematic search of literature on AHP related to RVE.

RESULTS

We identified nine cases of AHP related to RVE. Unexplained hypoglycemia (100%) and hypotension (66.7%) were the most common findings at presentation. AHP occurred after a median of 9 (range, 2-14) days after severe envenomation and was associated with multi-organ dysfunction, lower platelet counts, more bleeding and transfusions when compared to patients with RVE alone. The presence of clinically defined capillary leak syndrome, disseminated intravascular coagulation and mortality were not different from those without AHP. Our systematic search yielded 12 cases of AHP related to RVE; data on associated clinical manifestations, therapy and ASV administration were not available in most reports.

CONCLUSION

AHP is a very rare complication of RVE. Unexplained hypoglycemia and hypotension should prompt evaluation for AHP in RVE. AHP is associated with severe RVE, multi-organ dysfunction, bleeding and need for transfusion. Prompt treatment with steroids may reduce mortality related to AHP in RVE.

Does internal cardiac massage play a role in ROSC after prolonged CPR ? : Our experience in a tertiary care hospital

Cardiopulmonary resuscitation (CPR) is a life-saving skill involving chest compressions & ventilation to pump oxygenated blood through the vital organs of the body. Among different techniques and devices for chest compression, no single method has been definitively shown to produce the best outcome and hence, direct comparisons between them are not possible. Internal cardiac massage is the manual squeezing of the heart through a surgical incision into the chest cavity, when the chest is already open for cardiac surgery. Unlike the usual cardiac arrest scenarios, internal cardiac massage is employed mostly in cardiothoracic surgical patients and will have more chance for survival and favorable neurologic outcomes across all durations of CPR. We describe two cases of return of spontaneous circulation (ROSC) after prolonged CPR with internal cardiac massage performed in hospital setting.

Synthesis, structural analysis, theoretical studies of some lawsone derivatives

A series of lawsone derivatives are synthesized. The structures of the synthesized compounds are analyzed by FT-IR, Mass, Elemental analysis, (1)H, (13)C, HSQC, HMBC and theoretical studies.

The effect of nitridation temperature on the structural, optical and electrical properties of GaN nanoparticles

Nitridation at high temperature enhances the crystalline and optical quality of GaN nanoparticles synthesized by a novel chemical co-precipitation method.

In vitro anticandidal evaluation of novel highly functionalized bis cyclohexenone ethyl carboxylates

OBJECTIVES

Novel highly functionalized bis cyclohexenone ethyl carboxylates 7-12 were designed, synthesized and their structures were elucidated by their elemental analysis, MS, FT-IR, one-dimensional 1H, and 13C NMR spectroscopic data.

MATERIALS AND METHODS

All the synthesized compounds 7-12 were tested for their in vitro antifungal activities against Candida sp. namely Candida albicans, Candida tropicalis, Candida glabrata, Candida parapsilosis, Candida dubliniensis and Candida krusei.

RESULTS

A close inspection of the in vitro anticandidal activity profile in differently electron withdrawing (-F, -Cl, and -Br) functional group and electron donating (CH3 and OCH3) substituted phenyl rings of novel highly functionalized bis cyclohexenone ethyl carboxylates 7-12 exerted strong anticandidal activity against all the tested Candida species. All the synthesized compounds 7-12 exhibited MIC value in the range of 6.25-200 μg/mL against all the tested Candida (C.) species.

CONCLUSIONS

Compound 8 against C. albicans, 9,11 against C. glabrata, 8,10 against C. parapsilosis, 7,9 against C. dubliniensis, 8,10 against C. krusei exhibited excellent anticandidal activity at a MIC value of 6.25 μg/mL. Likewise compound 7, 9-11 against C. albicans, 8, 9, 11 against C. tropicalis, 8 against C. glabrata, 9 against C. parapsilosis, 10 against C. dubliniensis, 9 against C. krusei revealed superior activity at a MIC value of 12.5 μg/mL.

One pot synthesis, structural and spectral analysis of some symmetrical curcumin analogues catalyzed by calcium oxide under microwave irradiation

A series of sixteen number of curcumin analogues have been synthesized under microwave irradiation using calcium oxide as a catalyst. The synthesized compounds have been characterized using FT-IR, MS, elemental analysis, (1)H and (13)C NMR spectroscopic techniques. The UV-Vis absorption studies for these compounds have been studied in order to provide the electronic transitions taking place in the molecule. When compared to the curcumin ((1E,4Z,6E)-5-hydroxy-1,7-bis(4-hydroxy-3-methoxyphenyl)hepta-1,4,6-trien-3-one), the absorption maxima, λ(max) for all the synthesized curcumin analogues with a variety of substituents gets blue shifted i.e., hypsochromic shift was observed. This shift may be assigned to the change of dipole moment within the solvated molecule. Theoretical calculations regarding the optimization of the synthesized molecules, electronic properties like highest occupied molecular orbital (HOMO) and lowest unoccupied molecular orbital (LUMO) and mapped electron density surface diagrams were done. The geometrical energy, dipole moments and heat of formation values have also been calculated using the ArgusLab package by AM1 semi-empirical method.

SU-E-T-570: Improvement to the Histogram Analysis in Radiation Therapy (HART): An Open Source Software System for the Multi-Dimensional Dose- Volume Histogram Analysis in Digital Image Communication in Medicine - Radiation Therapy (DICOM-RT) Treatment Plans

PURPOSE

Histogram Analysis in Radiation Therapy (HART) is an efficient and accurate dose-volume histogram (DVH) computational tool in radiotherapy research. Several applications of the program have been presented previously (J Appl Clin Med Phys 11(1): 3013, 2010; Med Phys 38(6), p.3678, 2011) for the Radiation Therapy Oncology Group (RTOG) users. The program has been further developed to incorporate various types of DVH analysis features to support the research using DICOM-RT plans. The main objective of this work was to present the improvement and compatibility of the program for the DICOM-RT plans.

METHODS AND MATERIALS

MATLAB based codes were primarily designed to read and write a simpler HART format from the standard DICOM-RT data objects exported from the Xio treatment planning system (CMS Inc., St. Louis, MO). This format employed an optimal polynomial fitting technique to interpolate the co-ordinates of the contours in the regions-of-interest. The format was efficient for the (a) precise extraction of the cumulative DVH (cDVH) and spatial DVH (sDVH; x-,y-, and z-DVHs respectively) data- statistics, (b) universal-plan indices evaluation, (c) biological modeling based outcome analyses (BMOA), (d) radiobiological dose-response modeling, and (e) physical parameterization modules. The fundamental DVH statistics were validated using the DVH statistics extracted from the Computational Environment for Radiotherapy Research program.

RESULTS

HART offers various types of DVH computational functionalities, several plan evaluation and radiobiological outcome analysis modules in a user- friendly software package for the RTOG and DICOM-RT planners. The cDVH and BMOA modules were found to be the most applicable features for the global researchers.

CONCLUSIONS

HART is a novel and universal multi-dimensional DVH analysis tool for the radiation therapy research. We further expect to develop HART for the space-time DVH analysis and proton therapy applications. The software is available online (http://www2.uic.edu/∼apyaku1) for the radiotherapy research. This work was partially supported by NIH-NIDCD grant.

Cell-based assays using the fluorometric imaging plate reader (FLIPR)

A critical component of the drug discovery and development process is the identification of novel pharmacophores. Such discovery efforts are, in general, facilitated by rapid and high-throughput cell-based assays of receptor/ion channel-mediated signaling processes to screen diverse chemical libraries of compounds possessing activator or inhibitor activities at the desired target. The availability of the Fluorometric Image Plate Reader (FLIPR) has made rapid assays of cellular signaling processes feasible by simultaneous kinetics measurement of cell-based fluorescence changes in a 96- or 384-well format. This unit describes the application of the FLIPR in cell-based kinetic assays for measuring membrane potential changes and intracellular calcium dynamics.

Computer based haemodynamic guidance system is effective and safe in management of postoperative cardiac surgery patients

A circulatory guidance system, Navigator, was evaluated in a prospective, randomised control trial at six Australian university teaching hospitals involving 112 scheduled postoperative cardiac surgical patients with pulmonary artery catheters placed and receiving 1:1 nursing care. The guidance system was used to achieve and maintain physician-designated cardiac output and mean arterial pressure targets and compared these with standard post open-heart surgery care. The primary efficacy endpoint was the standardised unsigned error between the targeted and the actual values for cardiac output and mean arterial pressure, time averaged over the duration of cardiac output monitoring - the average standardised distance. This was 1.71 (SD=0.65) for the guidance group and 1.92 (SD=0.65) in the control group (P=0.202). Rates of postoperative atrial fibrillation, adverse events, intensive care unit and hospital length-of-stay were similar in both groups. There were no device-related adverse events. Guided haemodynamic therapy with the Navigator device was non-inferior to standard intensive care unit therapy. The study was registered with ClinicalTrials.gov Identifier NCT00468247.