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Summary Very few patients with liver metastases from colorectal cancer can be cured. We have investigated whether a treatment to slow the growth of liver metastases, hepatic-artery infusion of floxuridine, improves palliation in this setting. In a randomised study of 100 patients, we compared quality of life and survival in patients who received hepatic-artery infusion of floxuridine and in those who received conventional symptom palliation. 95% of control patient survival time was spent with normal quality-of-life scores, which suggests that the aim of treatment should be to prolong normal-quality survival rather than merely to sustain quality of life. There was a significant prolongation (p=0·03) in overall survival in floxuridine-treated patients compared with controls (median 405 vs 226 days). There were similar significant prolongations in normal-quality (ie, normal symptom scores) survival for physical symptoms (p=0·04), anxiety (p=0·04), and depression (p=0·04). This survival benefit was associated with significant reductions in metastasis size on computed tomography (p=0·001) and in serum carcinoembryonic antigen concentration (p=0·006) in floxuridine-treated patients. There was no evidence of treatment-related hepatotoxicity as assessed by serum aspartate aminotransferase and bilirubin measurements. This is the first demonstration that survival can be prolonged with normal quality of life in patients with colorectal liver metastases. We conclude that hepatic-artery floxuridine infusion can be recommended for suitable patients.

Hepatic arterial cannulation for regional chemotherapy was achieved in 121/134 (90.2%) of colorectal liver metastasis patients. The perioperative mortality (5.8%) was significantly greater (P = 0.004) in patients with > 1000 ml (5/22, 23%) compared with < 1000 ml (2/83, 2.4%) metastasis volume. Colorectal liver metastasis patients should be considered for regional chemotherapy before metastases become extensive.

Hepatic artery lymph node (HALN) involvement is an adverse prognostic factor in patients treated for colorectal liver metastases. The prevalence of HALN positivity for mid-gut and hind-gut derived colonic tumours, for differing amounts of liver involvement, and for Dukes' A and B versus Dukes' C primary tumours was compared in 75 patients with colorectal liver metastases. All patients whose primary tumours did not invade lymph nodes (Dukes' A or B) had liver metastases that did not involve local hepatic nodes, regardless of the extent of the disease within the liver. This suggests that factors controlling metastasis are not identical with those which control lymphatic invasion in colorectal cancer. HALN positive patients may benefit less from treatment because they are significantly more likely to have both a greater burden of disease within the liver and a tumour with greater lymph invasive potential than patients with HALN negative liver metastases.

ObjectivesTo objectively evaluate freely available data profiling software tools using healthcare data.DesignData profiling tools were evaluated for their capabilities using publicly available information and data sheets. From initial assessment, several underwent further detailed evaluation for application on healthcare data using a synthetic dataset of 1000 patients and associated data using a common health data model, and tools scored based on their functionality with this dataset.SettingImproving the quality of healthcare data for research use is a priority. Profiling tools can assist by evaluating datasets across a range of quality dimensions. Several freely available software packages with profiling capabilities are available but healthcare organisations often have limited data engineering capability and expertise.Participants28 profiling tools, 8 undergoing evaluation on synthetic dataset of 1000 patients.ResultsOf 28 potential profiling tools initially identified, 8 showed high potential for applicability with healthcare datasets based on available documentation, of which two performed consistently well for these purposes across multiple tasks including determination of completeness, consistency, uniqueness, validity, accuracy and provision of distribution metrics.ConclusionsNumerous freely available profiling tools are serviceable for potential use with health datasets, of which at least two demonstrated high performance across a range of technical data quality dimensions based on testing with synthetic health dataset and common data model. The appropriate tool choice depends on factors including underlying organisational infrastructure, level of data engineering and coding expertise, but there are freely available tools helping profile health datasets for research use and inform curation activity.

Protein hydrogels are hydrophilic biomaterials that swell and have material properties that resemble biological soft tissue. Hydrogels are appropriate for use in local drug delivery systems due to their extensive porous structure allowing diffusion. Hydrogels prepared from ex vivoanimal derived proteins bring risk of pathogens and ethical concerns. These issues can be addressed by using recombinantly produced spider silk. Spider silk protein (spidroin) is non-immunogenic, biodegradable and has impressive material properties such as strength and elasticity making it a promising material for hydrogel biomedical applications. In this study the recently reported highly expressing, recombinant mini-spidroin NT2RepCT was processed for the first time into natural protein hydrogels and characterised as a local and controlled drug delivery system.NT2RepCT self-assembled into physical hydrogels at 2.4 % (w/v) upon incubation at 37 °C in double distilled milli Q (MQ) water Tris, HEPES and CAPS buffers at pH 5.5, 7 and 10. The hydrogel’s optical properties, swelling behaviour, pore morphology, nanofibril structures, stiffness and rheological properties were tunable depending on gelation conditions. It was found NT2RepCT hydrogels formed at pH 10 had increased swelling, high light transmittance and increased stiffness compared to those formed at pH 7 or in MQ water. Glutaraldehyde chemical crosslinking was utilised to increase NT2RepCT hydrogel stiffness.The effect of hydrogel sample preparation ahead of scanning electron microscopy (SEM) on artefacts and secondary pores was investigated in cryo-SEM, high vacuum SEM and environmental SEM due to hydrogels high water content. It was found that the commonly used plunge freezing in liquid nitrogen technique created the most 3 artefacts compared to metal mirror (slam) freezing and in situlyophilisation exemplifying the need for careful hydrogel SEM sample preparation.The NT2RepCT hydrogels formed at pH 10 and in MQ water were injectable and showed shear-thinning properties. These hydrogels were assessed as a controlled drug delivery system and showed pH dependent release of the model drug surrogate rhodamine B. Tyrosine conjugation of 4-(4-(2-azidoethoxy)phenyl)-1,2,4-triazolidine3,5-dione (PTAD-azide) added a functional handle and the model drug surrogate fluorescein (FAM) was ‘clicked’ via copper catalyzed azide-alkyne cycloaddition. Improved and controlled release was seen in hydrogels containing conjugated FAM compared to hydrogels containing non-conjugated ‘free’ FAM.The properties of the NT2RepCT hydrogels were similar to previously reported natural and recombinant silk hydrogels but without the need for high temperatures, denaturing purification conditions and extensive processing. This study illustrates the diversity and tunability of recombinant minispidroin NT2RepCT hydrogels and demonstrates their suitability as a highly transparent, injectable, pH sensitive and controlled hydrogel drug delivery system.

Langerhans cell histiocytosis is characterized by the abnormal nodular proliferation of histiocytes in various organ systems. Pulmonary involvement seen in young adults is nearly always seen in the context of past or current cigarette smoking. Although it tends to be a single-system disease, extrapulmonary manifestations involving the skin, bone, and hypothalamic-pituitary-axis are possible. High resolution CT (HRCT) of the thorax findings includes centrilobular nodules and cysts that are bizarre in shape, variable in size, and thin-walled. Often the diagnosis can be made based on the appropriate clinical presentation and typical imaging findings. Treatment includes smoking cessation and the potential use of glucocorticoids or cytotoxic agents depending on the severity of disease and multisystem involvement.

Around 2007, I started gathering small number of Colorado-based Filipino Nurses, who I personally know. [...]I was able to form the chapter of PNAA in Colorado. The meetings provided opportunities where both parties could exchange dialogues about safety, especially around the use of appropriate PPE (personal protective equipment), as we needed to conserve PPEs due to their limited supply. The high-priority opportunities they identified were education about the basics of ventilator management, medication administration through enteral feeding tube, and proning and repositioning the ICU patients. With the help of some of our ICU nurses, we were able to create relevant educational objectives, develop a curriculum, and provide classroom and simulated hands-on education.

The CCBN Space Talks was a six-month virtual expedition that explored breaking barriers in space discovery for the next generation via a series of action-oriented and solution-based conversations that culminated in the upcoming launch of the CCBN Space Expo. How does CCBN help advance Black nurses and student nurses? CCBN advances not only Black nurses but the nursing profession through providing mentoring, networking, legislative, and community engagement opportunities to optimize the nurse education experience and facilitate successful entry into meaningful practice, all while meeting the needs of underserved communities through free services and health education. The mission of the Colorado Council Black Nurses, Inc. is to improve the health status of all people through empowering underserved communities to be equal contributors in the determination of healthcare standards by increasing the number of Black/African American professional nurses throughout the healthcare continuum, and by increasing college matriculation and successful graduation rates among Black and other underrepresented students in postsecondary education, thereby empowering under-served communities to not only be participants but active contributors to an equitable health care system in local, national and global arenas.

According to a 1967 Colorado Nurse article that CNA's Dr. Colleen Casper RN shared at the annual conference, aerospace flight nursing has been cited as early as July 1, 1949 with the formation of the US Air Force Nurse Corps. CNA was expertly represented by CNA members Dr. Annette Cannon RN and Dr. Armi Earlam RN as both contributors to the space expo as well as panelists at the CCBN Space Talks, a six-month virtual expedition that analyzed the space industry barriers nurses face and explored breaking those barriers in space discovery for the next generation via a series of action-oriented and solution-based conversations that culminated in the launch of the CCBN Space Expo in Colorado in September of 2021. Comprised of a multi-generational network of leaders, pioneers, visionaries, and students in the profession of nursing and nurse pathway careers, CCBN addresses health equity from a cultural perspective with a focus on improving the health status of ALL people.