Notes

Nuclear Force Microscopic lense Nanoindentation Investigation of Diffuse Astrocytic Growth Flexibility: Relationship along with Cancer Histopathology.
[J Nurs Educ. 2022;61(9)545-548.].
Ambient air pollution (AAP) has become an important health problem globally. Besides, several pieces of evidence indicate that air pollutants such as sulfur dioxide (SO
) and ozone (O
) are major contributors to a wide range of non-communicable diseases. The present study investigated the effects of AAP, sulfur dioxide, and ozone on oxidative stress, histopathology, and some apoptosis-related genes expressions of lung tissue in a rat model.

Thirty-two Wistar rats were randomly divided into the control, AAP, sulfur dioxide (10 ppm), and ozone (0.6 ppm) groups. After five consecutive weeks' exposure to the selected pollutants (3 h/day), lung tissues were harvested and immediately fixed with formalin. The samples were routinely processed, sectioned, stained with hematoxylin and eosin (H&E), and finally assessed for presence of pathological changes. Expression changes of BAX, p-53, EGFR, caspase-3, caspase-8 and caspase-9 were assayed using the RT-qPCR method. One hundred milligrams of lung tissues wereesult of the induced oxidative stress in the lung tissues.
The results indicated induction of oxidative stress. Our results suggest the apoptosis stimuli effect of AAP and also the extrinsic apoptotic pathway trigger effect of sulfur dioxide and ozone in the lung tissue in the concentrations used in the present study. The histopathological and the genes expression changes may be a result of the induced oxidative stress in the lung tissues.Atherosclerotic heart disease is the leading cause of mortality and morbidity in the USA. Low density lipoprotein (LDL) has been the target for many hypolipidemic agents to modify atherosclerotic risk. Bempedoic acid is a novel hypolipidemic drug that inhibits the enzymatic activity of ATP citrate lyase in the cholesterol synthesis pathway. CLEAR Harmony, CLEAR Wisdom, CLEAR Tranquillity and CLEAR Serenity have shown safety and efficacy associated with long term administration of this drug. Studies have shown effectiveness in reducing LDL-C in both statin intolerant patients and in patients on maximally tolerated doses of statin. The fixed drug combination of bempedoic acid and ezetimibe in a recent phase III showed significant reduction in LDL compared with placebo, which might be a promising future for LDL reduction among statin intolerant patients. Bempedoic acid also reduced inflammatory markers like hs-CRP. Given these results, bempedoic acid alone and in combination with ezetimibe received the USA FDA approval for adults with heterozygous familial hypercholesterolaemia or established atherosclerotic cardiovascular disease. We present a comprehensive review exploring the underlying mechanism, pre-clinical studies, and clinical trials of bempedoic acid and discuss the potential future role of the drug in treating hyperlipidaemia.Cancer-associated fibroblasts (CAFs) have conflicting roles in the suppression and promotion of cancer. Current research focuses on targeting the undesirable properties of CAFs, while attempting to maintain tumour-suppressive roles. CAFs have been widely associated with primary or secondary therapeutic resistance, and strategies to modify CAF function have therefore largely focussed on their combination with existing therapies. Despite significant progress in preclinical studies, clinical translation of CAF targeted therapies has achieved limited success. Here we will review our emerging understanding of heterogeneous CAF populations in tumour biology and use examples from pancreatic ductal adenocarcinoma to explore why successful clinical targeting of protumourigenic CAF functions remains elusive. Single-cell technologies have allowed the identification of CAF subtypes with a differential impact on prognosis and response to therapy, but currently without clear consensus. Identification and pharmacological targeting of CAF subtypes associated with immunotherapy response offers new hope to expand clinical options for pancreatic cancer. Various CAF subtype markers may represent biomarkers for patient stratification, to obtain enhanced response with existing and emerging combinatorial therapeutic strategies. Thus, CAF subtyping is the next frontier in understanding and exploiting the tumour microenvironment for therapeutic benefit. © 2022 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
Nursing schools across the country have dedicated themselves to diversifying their enrollment to influence the diversification of the nursing workforce. They often seek examples of best practices to pursue inclusive excellence within their organization. This article provides the best strategies for engaging in this work.

The author provides reflections from 7 years of experience diversifying and retaining underrepresented populations at an academic health science center and consulting site visits to several schools of nursing across the country.

Seven best practice strategies are identified to enhance diversity, equity, and inclusion in nursing education.

Institutions that are committed to diversifying their enrollment engage in intentional strategies to focus on inclusive excellence and success for all members of their learning community.
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Institutions that are committed to diversifying their enrollment engage in intentional strategies to focus on inclusive excellence and success for all members of their learning community. [J Nurs Educ. 2022;61(9)542-544.].
Advocacy is widely recognized as a nursing responsibility. Speaking up, a form of advocacy, is known to benefit patient safety and quality of care yet research shows that nurses are hesitant to speak up and face multiple barriers when deciding to do so.

A toolkit that included web-based learning modules and simulation experience with a standardized patient was developed to enhance advocacy skills in baccalaureate nursing students. Student perceptions of the efficacy of this approach were used to revise and improve toolkit materials.

There were 131 participants over four semesters. Students reported the toolkit helped them understand how to use advocacy skills (87%), allowed them to use critical thinking (97%), and practice advocacy (94%).

Educational experiences like this promote development of students' advocacy skills in a safe environment and can be used to bridge the gap between expectation and practice.
.
Educational experiences like this promote development of students' advocacy skills in a safe environment and can be used to bridge the gap between expectation and practice. [J Nurs Educ. 2022;61(10)599-602.].The United States population is becoming increasingly diverse. Data show increased utilization of Mohs micrographic surgery (MMS) in people of color. Though the incidence of skin cancer in skin of color is low, morbidity and mortality are disproportionately high. Still, published literature on the topic is lacking. In this article, we outline our approach to MMS in skin of color. THR inhibitor We review salient topics not published elsewhere in literature in this context, including post-operative postinflammatory hyperpigmentation and suture selection in skin of color. Our goal is to better equip dermatologic surgeons for the rapidly changing demographics of our patient population. We feel this is an important step in addressing the dire health disparities associated with skin cancer in skin of color. J Drugs Dermatol. 2022;21(5)536-541. doi10.36849/JDD.6469.
There is a wide variety in utilization of opioids during Mohs Micrographic Surgery (MMS) despite evidence that a multimodality approach may be more beneficial.

To evaluate prescription opioid use at our institution and subsequent pain-related patient communication following MMS.

This was a retrospective cohort study involving 2360 patients who underwent MMS. Patient and operative characteristics in relation to opioid use in the peri-operative period were compared using univariate and bivariate statistical measures.

A total of 306 patients (13%) were prescribed opioids postoperatively. However, receipt of opioids is associated with greater odds of pain-related patient communication (OR=6.2; 95% CI3.3–11.4). Opioid type was not significantly associated with reported pain (OR=0.7; 95% CI0.3–1.8).

Consistent with existing guidelines, certain patient and operative characteristics such as age, number of Mohs stages, repair type, and anatomic site were associated with greater odds of receiving opioids. While certain patients may require opioids for adequate pain control, in our cohort, opioid use was associated with increased odds of pain-related patient communication post MMS. J Drugs Dermatol. 2022;21(5)551-554. doi10.36849/JDD.5742.
Consistent with existing guidelines, certain patient and operative characteristics such as age, number of Mohs stages, repair type, and anatomic site were associated with greater odds of receiving opioids. While certain patients may require opioids for adequate pain control, in our cohort, opioid use was associated with increased odds of pain-related patient communication post MMS. J Drugs Dermatol. 2022;21(5)551-554. doi10.36849/JDD.5742.The intent of this brief communication is to describe a unique incomplete staining frozen section pathology artifact encountered during Mohs Micrographic Surgery. At the authors’ institution, an amorphous, eosinophilic artifact that obscured cellular architecture was observed multiple times during histological interpretation. It was determined that incomplete tissue staining was likely caused by weak staining, possibly related to an interaction between hematoxylin dye solution and acetone. We adjusted our SLS stain line protocol by adding a 15 second water rinse between the acetone and hematoxylin pots and then compared the old fixation protocol with our new fixation protocol. This artifact, which was regularly found intraoperatively at five separate MMS laboratories has sustainably resolved. Mohs Micrographic Surgery (MMS) is a dermatologic procedure that includes tumor extirpation, tissue grossing, slide preparation, and microscopic histologic interpretation. Tissue grossing and slide preparation are vital components of the MMS procedure. There are many steps throughout tissue processing that can result in frozen section pathology artifacts. Frequently encountered frozen section pathology artifacts include vacuolation of cytoplasm or “freeze artifact,” overstaining and understaining with hematoxylin and eosin, incomplete dehydration, and splaying of collagen in the dermis.1-3 We describe a unique incomplete staining frozen section pathology artifact. J Drugs Dermatol. 2022;21(5)542-544. doi10.36849/JDD.6722.Nivolumab (anti PD-1 antibody) and ipilimumab (anti CTLA-4 antibody) are immune checkpoint inhibitors (ICI) that effectively stimulate the native T cell response and lead to an antitumor response. The medications have been approved for the treatment of metastatic melanoma. However, ICIs are associated with higher risk for cutaneous immune-related adverse events (irAEs). Although most of the adverse events present as maculopapular rash, some patients develop Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis which are dermatologic emergencies with high mortality. We report a fatal case of SJS associated with nivolumab and a non-fatal case of TEN with nivolumab/ipilimumab combination therapy in patients with metastatic melanoma. It is also not unusual to develop SJS or TEN after weeks or months on checkpoint inhibitor therapy. Given the high rate for mortality, dermatologists and other clinicians should closely follow any rash from these immunotherapies due to the risk for future development of SJS or TEN.
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