"Building bridges"-communication education for residents in radiology: a scoping review

BACKGROUND

Good communication is an important professional attribute for radiologists. However, explorations of communication education and their outcomes in radiology residents are sparse. This scoping review aims to evaluate the existing literature on communication education for radiology residents, identify gaps in current practices, and suggest directions for future studies.

METHODS

A scoping review following the six-step approach of Arksey and O'Malley was undertaken. We searched through PubMed, Embase, ERIC, and Web of Science databases, focusing on communication education in radiology residents.

RESULTS

Sixteen of the 3096 identified articles were included in the analysis. Most studies (13/16) originated from the United States. The studies varied in study design, including quantitative, qualitative and mixed-methods approaches. The sample sizes of most studies were small to moderate, with more than half of the studies had fewer than 30 participants. The identified studies predominantly focused on communication with patients and healthcare professionals. The need for communication education, the efficacy of specific communication education programs, and the capability of some assessment tools for evaluating residents' communication skills were investigated.

CONCLUSIONS

This scoping review reveals the gap between the need for communication education and the lack of comprehensive education programs in radiology residents globally. Future studies should develop tailored interventions and use reliable assessment tools, engaging more participants with extended follow-up periods, and expand the scope of communication training to include all relevant stakeholders.

Effectiveness and safety of apixaban vs warfarin among older venous thromboembolism patients: a subgroup analysis of age

Background

Venous thromboembolism (VTE) is the third most common cardiovascular condition in adult patients. Older patients are at an increased risk of VTE. However, they have been underrepresented in clinical trials and evidence on the safety and effectiveness of anticoagulants in older VTE patients, especially very elderly patients (≥80 years), is sparse.

Purpose

To evaluate the risk of recurrent VTE, major bleeding (MB), and clinically relevant non-major (CRNM) bleeding among older VTE patients initiating apixaban or warfarin according to two age sub-groups: 65–79 and ≥80 years.

Methods

Older VTE patients (aged ≥65 years) who initiated apixaban or warfarin were identified from the CMS Medicare database (September 2014–December 2017). To balance the characteristics between apixaban and warfarin patients, stabilized inverse probability treatment weighting (IPTW) was conducted. Post IPTW, a subgroup interaction analysis was conducted to evaluate if there was any difference in treatment effects between the two age subgroups (65–79 vs. ≥80) on recurrent VTE, MB, and CRNM bleeding. Cox proportional hazard models were used to conduct the interaction analysis, and the statistical significance of the interaction was set to p-value <0.10.

Results

A total of 22,135 apixaban and 45,840 warfarin patients with VTE aged ≥65 years were eligible for analysis. Post IPTW, patient characteristics were balanced between the apixaban and warfarin treatment cohorts. Apixaban patients had significantly lower risk of recurrent VTE, MB, and CRNM bleeding compared to warfarin patients (Figure). 42,551 (62.6%) were aged 65–79 years and 25,424 (37.4%) were aged ≥80 years. Among apixaban or warfarin patients, those aged 65–79 years had lower Charlson comorbidity index scores (mean 2.7 vs 3.2) and were less likely to have a diagnosis of anemia (34.7–34.9% vs 42.3–42.5%), cerebrovascular disease (14.7–15.7% vs 20.3–20.5%), or dementia (5.0–6.9% vs 20.4–24.6%) compared to patients aged ≥80 years. Across both age subgroups, incidence rates of recurrent VTE, MB and CRNM bleeding were lower for apixaban vs. warfarin. No significant interaction was observed between the treatment and age on recurrent VTE and MB (Figure). There was a significant interaction between treatment and age on CRNM bleeding. Apixaban trended towards a lower risk of CRNM bleeding across both age groups but the treatment effect on CRNM bleeding was larger for patients aged 65–79 years.

Conclusion

The treatment effects of apixaban vs. warfarin on recurrent VTE and MB were consistently observed across both older age groups in this analysis. More studies are needed to evaluate management of VTE in an older and especially the very elderly population.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Bristol-Myers Squibb Company and Pfizer Inc.

Effectiveness and safety of apixaban vs warfarin among older venous thromboembolism patients stratified by race

Background

Race has been identified as a risk factor for venous thromboembolism (VTE), with Black individuals having a higher risk of VTE compared to Caucasians. Black patients have been underrepresented in clinical trials evaluating anticoagulants for VTE. There has been limited evidence about the effects of anticoagulants for Black patients with VTE in routine clinical practice.

Purpose

To evaluate the risk of recurrent VTE, major bleeding (MB), and clinically relevant non-major (CRNM) bleeding among VTE patients initiating apixaban or warfarin stratified by race.

Methods

Older VTE patients (≥65 years) who initiated apixaban or warfarin were selected from the CMS Medicare database (September 2014–December 2017). Stabilized inverse probability treatment weighting (IPTW) was used to balance the differences between apixaban and warfarin cohorts. After IPTW, subgroup interaction analysis was conducted to evaluate if treatment effects were different between Black and White patients in the Medicare population. Due to small sample size, other races were not included in the interaction analysis. Cox proportional hazard models were used to evaluate if there was significant interaction (p<0.10) between treatment and race on recurrent VTE, MB, or CRNM bleeding.

Results

A total of 22,135 apixaban and 45,840 warfarin patients with VTE were included in the analysis. Post-IPTW, patient characteristics were balanced between apixaban and warfarin treatment cohorts. Apixaban patients had significantly lower risk of recurrent VTE, MB, and CRNM bleeding compared to warfarin patients (Figure). When stratified by race, 57,008 (83.9%) were White, 7,832 (11.5%) Black, and 3,135 (4.6%) other races. For both treatment cohorts, age was similar between Black (77.0–77.2 years) and White (77.4–77.5 years) patients. However, Black patients were more likely to have an inpatient VTE event (77.3–77.8% vs. 63.1–63.3%), a provoked VTE event (78.6–79.5% vs 69.4–69.6%), and a higher comorbidity index score (mean 4.1 vs. 2.7) compared to White patients with VTE. The incidence rates per 100 person-years of recurrent VTE (2.0–3.3 vs 1.4–2.2) and MB (7.4–10.1 vs 3.5–5.3) were also numerically higher for Black patients compared to White patients. Across both race groups, apixaban patients had a lower incidence rate of recurrent VTE, MB and CRNM bleeding compared to warfarin patients. No significant interaction was observed between treatment and race for recurrent VTE, MB, or CRNM bleeding (Figure). The findings within each race group were consistent with those of the overall VTE population.

Conclusion

Among older VTE patients, disparities were observed in VTE characteristics and clinical outcomes between Black and White patients. Across both race groups, apixaban had lower risk of recurrent VTE, MB, and CRNM bleeding compared to warfarin patients. Further studies are needed to identify optimal management strategies for Black patients with VTE.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Pfizer IncBristol-Myers Squibb Company

[Effects of CD11/CD18 antibody on adhesive force between polymorphonuclear neutrophil and endothelial cell in response to burn serum in vitro]

Our previous studies have proved that a great number of polymorphonuclear neutrophils (PMN) adhered to endothelial lining and induced endothelial cell (EC) injury. This study was attempted to investigate the change in adhesive force between PMN and EC in response to burn patients' serum within 24 hours and effects of antibody against CD11/CD18 on PMN-EC adhesive force. Burn serum was isolated from 4 burn patients (III degrees 20%-50% TBSA) within 48 hours after burn injury. PMNs were isolated from 8 volunteers. Adhesive force between a PMN and a HUVEC was calculated by means of micropipette technique at 1 h, 3 h, 6 h, 12 h, 24 h after PMN or HUVEC incubated with burn serum or normal serum. Five individual PMN-HUVEC pairs were measured for each sample. All data were analyzed statistically using the t test.

RESULTS

1. The adhesive force between a single PMN-HUVEC pair increased sharply after PMN incubated with burn serum, which reached the maximun level at 1 h after incubation and remained at this level in the following 23 hours. However, the adhesive force was reduced by 78.5%, 72.5%, 75.2% at 1 h, 6 h, 24 h, respectively after the PMNs were pretreated with CD11/CD18 mAb; 2. The adhesive force between a single burn serum stimulated-HUVEC and PMN pair increased gradually, reached peak at 12 h and remained at this level in the following 12 hours.

CONCLUSIONS

Burn serum could induce PMN-EC adhesion, with related to PMN aggregation in internal organs and EC damage after burn injury. Antibodies against CD11/CD18 could partially block PMN-EC adhesion and might reduce EC injury induced by activated PMNs.

[Study on major metabolites of 3H-1,2-dihydro-2-(4-methylphenylamino)-methyl-1-pyrrolizinone in rabbits]

The metabolites of a 750 mg oral dose of Z-47 [3H-1, 2-dihydro-2-(4-methylphenylamino) methyl-1-pyrrolizinone], a new anti-inflammatory and analgesic agent, in rabbit urine were separated and detected with high performance liquid chromatographic method. On basis of the chromatographic behavior of Z-47 metabolites and biotransformation pathways of drugs with partial structure of Z-47, the carboxylic derivative of Z-47 [4-(3H-1, 2-dihydro-1-pyrrolizinone-2-methylamino) benzoic acid] was proposed as a potential metabolite so that the compound was synthesized. The authentic substance was then compared with one of the metabolites by the chromatographic retention time and the ratio of their UV-absorbances at two wavelengths. The enzyme-hydrolyzed product of another metabolite was also analysed. It was consequently confirmed that the carboxylic derivative of Z-47 and its acyl beta-D-glucuronide are major metabolits of Z-47 in rabbits.

[Expression of glutathione S-transferase-pi in human esophageal squamous cell carcinoma]

OBJECTIVE

To evaluate the expression of glutathione S-transferase-pi (GST-pi) in human esophageal squamous cell carcinoma (ESCC) and its correlation with the clinicopathological data.

METHODS

Immunohistochemical method (labeled avidin biotin method) and ELISA were used to detect the expression of glutathione S-transferase-pi (GST-pi) in 143 cases of formalin fixed, paraffin embedded ESCC tissue sections. Serum GST-pi was determined before and after operation in 43 patients with ESCC.

RESULTS

GST-pi was positively stained immunohistochemically in 58.7%(84/143) of ESCC and 79.6%(109/139) of surrounding noncancerous esophageal tissues (P < 0.05). The expression level of GST-pi was significantly higher in well differentiated than poorly differentiated carcinomas(P < 0.05). No significant correlation was observed between GST-pi levels and lymph node metastasis, pathological staging or long term survival. The preoperative and postoperative mean serum GST-pi levels in ESCC patients were significantly higher than those in 34 normal subjects (P < 0.05, P < 0.025); the mean serum GST-pi level in postoperative patients was lower than that in preoperative patients, but the difference was not significant.

CONCLUSION

GST-pi is a useful tumor marker for human ESCC.

[The combination of cyclosporin A and androgen in the treatment of chronic aplastic anemia]

OBJECTIVE

To explore the therapeutic effectiveness of combination of cyclosporin A (CsA) and androgen in the treatment of chronic aplastic anemia (CAA).

METHOD

Androgen alone or combined with CsA for the treatment of CAA was compared by a randomized controlled clinical trial.

RESULT

The efficacy of androgen combined with CsA (87.9%) was higher than that of androgen alone (57.1%). Therapeutic effectiveness of the combination treatment between the patients with positive and negative peripheral blood mononuclear cells (PBMNCs) inhibiting normal colony formation unit-granulocyte and macrophage (CFU-GM) test showed a significant difference (P < 0.005).

CONCLUSION

Androgen combined with CsA had a much better efficacy than that of androgen alone in the treatment of CAA. The patients' PBMNCs inhibiting normal CFU-GM growth test can be used as an index of the treatment outcome. The side effects of the combination therapy are low and tolerable.

[The effect of brain-derived neurotrophic factor on the rat electroretinography after pressure-induced ischemic injury]

Brain-derived neurotrophic factor (BDNF) or normal goat serum (NGS) was injected intravitreously in each 11 wistar albino rats two days before the induction of ischemia. Retinal ischemia was induced in 22 rats by increasing intraocular pressure to the threshold level which extinguished the electroretinography (ERG) b-wave individually, and maintaining for 90 minutes. The ERG b-wave of the BDNF-treated rats recovered to 80.5 +/- 24.4% of their normal amplitude three days after ischemia, while that of the NGS-treated rats recovered only to 11.1 +/- 5.3%. Statistic analysis showed that the recovery level of ERG b-wave after ischemia in the BDNF and NGS treated rats was significantly different (P < 0.01). The results suggest that BDNF could promote the recovery of the retinal electrophysiologic function from ischemia induced by high intraocular pressure.

[Effect of stud attachment post design on dentin stress distribution]

The shape design of attachment post is crucial factors influencing post retention and stress distribution to the dentin. By means of CAD and FEA, the present study investigated the effects of the shape designs of attachment posts on the stress distribution in dentin. The results indicated that the taper post had wedging effects on the dentin and produced higher Von Misses stress than that of parallel side post and the Von Misses stress value of the dentin was about 1.1 times. The maximum Von Misses stress value that the design of the thread post produced was about 1.06 times the stress of the nonthread post did. However, the effects of post design on the dentin were minor compared with the bite force directions. In the same post design, the maximum Von Misses stress in dentin with 45 degree oblique force was about 2.1 times with vertical force. Therefore, reducing oblique force is the main method to prevent root fracture in clinic.

[Studies on the isolation, culture and DNA identification of mycelia of Tricholoma matsutake]

The tissue isolation for Tricholom matsutake(S Ito et Imai) Sing were made with 8 media in 810 test tubes from different positions of 9 basidiocarps of different source and from mycorrhizae, and soil with the fungi in the studies. The results showed that 94 test tubes of slow-growing mycelia were isolated from lamellae and their success percentages of isolation with media PDAS, PDAW, BM, PDA were 74.4%, 355%, 15.6% and 8.9% respectively. The fast-growing mycelia were easily got from the mycorrhizae and soil related to matsutake. The isolates with different culture characteristics were appraised through DNA fingerprinting comparison with matsutake basidiocarps collected from Jilin province, China and reference isolates presented by matsutake research workers of China and Japan, in which RAPD (Random Amplified Polymorphic DNA)-PCR patterns were sharply prepared using 17 arbitrary decamer nucleotide primers screened. The statistical data indicated that all slow-growing mycelia isolated from lamellae had the same DNA fingerprinting patterns as their origin basidiocarps tissues such as pileus (containing lamellae) and stipe, whose similarity coeffecients all were 1.000, and were therefore identified as true Tricholoma matsutake. However, the fast-growing mycelia or yeast colony were identified as not matsutake. The results suggested that matsutake and its own mycelia have DNA homogeneity, and there exists no any other microbe in the basidiocarps. The results also demonstrated that all matsutake from east China and reference isolates of matsutake from southwest China and Japan were one same species Tricholoma matsutake, whose DNA similarity coeffecients varied from 0.934 to 0.994.

[Study on P forms in extracellular polymeric substances in enhanced biological phosphorus removal sludge by 31P-NMR spectroscopy]

The present paper investigated phosphorus forms in the extracellular polymeric substances (EPS) using 31P-NMR spectroscopy, and analyzed the influential parameters for this method. The results showed that in the three investigated EPS samples five P forms were identified, including orthophosphate, orthophosphate monoesters, DNA, pyrophosphate and polyphosphate. And in the EPS extracted from A/A/O sludge and A/A/O-MBR sludge polyphosphate was the main phosphorus form. This indicated that P is contained in the EPS not only owing to the adsorption of orthophosphate, but also because EPS acting like the bacteria cells contributes to enhanced biological phosphorus removal. Furthermore the transformation of P forms in the EPS during the EPS extraction was found but limited within 1 h. It was found that with the NaOH solution added the polyphosphate in the EPS would partly convert to pyrophosphate but not go further to orthophosphate, while with pure water added P forms in the EPS were very stable. This means that after neutralization, the transformation of phosphorus forms could be avoided. Since the measurement of 31P-NMR spectroscopy was very sensitive to pH, which could affect the chemical shift of the peaks and cause peaks overlapping, the pH of EPS sample must be raised to 13.0 before the measurement.

[Spatial Distribution, Spectral Characteristics, and Sources Analysis of Dissolved Organic Matter from Baiyangdian Lake in Xiong'an New District During the Winter Freezing Period]

Based on excitation emission matrix spectroscopy (EEMs) technology combined with parallel factor analysis (PARAFAC) and ultraviolet-visible (UV-vis) spectra, we analyze the spatial distribution, spectral characteristics, and sources of dissolved organic matter (DOM) in Baiyangdian Lake, China, during a winter freezing period. Results showed that the UV-vis absorption spectrum of DOM had no obvious characteristic peak, and that the variation coefficient of absorption exhibited a significant difference (P<0.05) among different districts of Baiyangdian Lake, but that there was no significant difference between the surface and bottom waters. The changes of E3/E4, E2/E3, and S_R showed that DOM had low humic and autochthonous characteristics. Two protein-like substances (C1 and C2) and one humic-like substance (C3) were identified by PARAFAC, with a significant correlation (P<0.001) being found between C1 and C3, and C2 and C3. The total DOM fluorescence intensity and the fluorescence intensity of each component exhibited significant differences (P<0.01) in the distribution among the different districts of Baiyangdian Lake, with the maximum value being associated with a sample from the Tanghe River and the minimum value being associated with a sample from Shaochedian. Moreover, the sum of C1+C2 accounted for the major proportion of DOM. DOM exhibited a strong autochthonous characteristic based on the values of BIX, FI, and HIX. Principle component analysis (PCA) and Adonis analysis showed that the spectral characteristics of DOM exhibited a significant difference (P<0.05) among the different districts. C1, C2, and C3 were significantly correlated (P<0.001) with DOM indices (HIX, BIX, Fn280, and Fn355) and water quality parameters[total nitrogen (TN), permanganate index, and total dissolved phosphorus (TDP)] based on multiple linear regression. Our results contribute to previous investigations and provide findings that can assist in the future management and control of organic carbon pollution sources to Baiyangdian Lake.

[Identification and analysis of the proteins interacted with Prestin in cochlear outer hair cells of guinea pig]

Objective: To explore the regulation and mechanism of Prestin protein by identifying the proteins interacted with Prestin in cochlear outer hair cell(OHC) and analyzing their biological function. Methods: Co-immunoprecipitation combined mass spectrometry technology was used to isolate and identify the proteins interacted with Prestin protein of OHC, bioinformatics was used to construct Prestin protein interaction network. The proteins interacted with Prestin in OHC of guinea pig were determined by matching primary interaction mass spectrometry with protein interaction network, and annotated their functions. Results: The results of co-immunoprecipitation combined with mass spectrometry showed that 116 kinds of credible proteins could interact with Prestin. By constructing Prestin protein interaction network, matching the results of mass spectrometry and analyzing of sub-cellular localization, eight kinds of proteins were confirmed that they interacted with Prestin directly, namely EEF2, HSP90AB1, FN1, FLNA, EEF1A1, HSP90B1, ATP5A1, and ERH, respectively, which were mainly involved in the synthesis and transportation, transmembrane folding and localization, structural stability and signal transduction of Prestin protein. Conclusion: EEF2, HSP90AB1, FN1, FLNA, EEF1A1, HSP90B1, ATP5A1 and ERH provide molecular basis for sensory amplification function of OHCs by participating in biotransformation, transmembrane folding and localization, signal transduction and other biological processes of Prestin protein.

[Spectral Characteristics and Sources of Dissolved Organic Matter With Different Relative Molecular Weight from Rainwater From Summer and Autumn in the Zhoucun Reservoir Based on UV-Vis and EEMs]

Based on excitation emission matrix spectroscopy (EEMs) technology combined with parallel factor analysis (PARAFAC) and UV-Vis spectra, we analyzed the spectral characteristics and sources of dissolved organic matter (DOM) in rainwater with different DOC molecular weight in summer and autumn in the Zhoucun Reservoir. The results show that the UV-Vis absorption spectrum of DOM have no notably characteristic peak and the variation coefficient of the absorption coefficient ranges between 75% and 469%, which shows the properties of DOM with different molecular weight. The changes of a₂₅₄ and E3/E4 show that the relative concentration of DOM and the proportion of fulvic acid in DOM both increase from summer to autumn, respectively; Two humic-like substances (C1, C2), one fulvic-like substance (C3), and one protein-like substance (C4) were identified with the PARAFAC model, with a significant correlation coefficient (P<0.01) in C1&C2/C3/C4 and C2&C3, respectively. The total DOM fluorescence intensity and the fluorescence intensity of each component exhibit significantly different distributions (P<0.01). Moreover, C1+C2 account for the majority proportion of DOM and C3 and C4 exhibit an increase and decrease from summer to autumn, respectively. The rainwater in summer and autumn both exhibita strong autochthonous component characteristics and the summer rainwater has higher autochthonous characteristics. The PCA shows that the spectral characteristics of the rainwater exhibit notable differences. Moreover, C1, C2, and C3 exhibit a significant correlation coefficient (P<0.01) with DOM indices[HIX, Fn(355), Fn(280), E3/E4, a₂₅₄] and water quality parameters. The results contribute to the future exploration and control of organic carbon pollution sources by managers of the Zhoucun Reservoir.