bluuebunny/crossref_metadata_2025 huggingface dataset:
Podophyllotoxin‐combined 5‐aminolevulinic acid photodynamic therapy significantly promotes HR‐HPV‐infected cell death
Authors: Wang Jingying , Wang Qi , Chen Pingjiao , Li Qian , Li Zhijia , Xu Meinian , Zeng Kang , Li Changxing
Published: November 2021

Background

Human papillomavirus (HPV) infection and related diseases are difficult clinical challenges. The efficacy of 5‐aminolevulinic acid photodynamic therapy (ALA‐PDT) in treating condyloma acuminata is remarkable, with high virus clearance and low recurrence rates. Podophyllotoxin (POD) is the first‐line drug with a significant therapeutic effect on condyloma acuminata. However, no studies have determined whether POD‐combined ALA‐PDT improves high‐risk (HR)‐HPV‐infected cell killing. We aimed to investigate whether POD‐combined ALA‐PDT could promote HPV‐infected cell death more effectively than the single treatment and explore the underlying mechanism.

Methods

In HeLa and SiHa cells, flow cytometry, EdU assay and LDH release test were used to detect apoptosis, cell proliferation change and necrosis, respectively. To investigate whether the combined therapy might activate apoptosis and induce endoplasmic reticulum (ER) stress, flow cytometry was used to determine intracellular levels of ROS and calcium, and Western blotting was used to determine the expression of related proteins. Mitochondrial membrane depolarization was detected by JC‐1 assay. Immunofluorescence staining and Western blotting were used to detect the activation of autophagy.

Results

Podophyllotoxin ‐combined ALA‐PDT inhibited the proliferation and promoted apoptosis and necrosis more effectively than the single treatment at the same intensity and concentration. The activation of the caspase‐dependent apoptosis pathway, ER stress and autophagy was more substantial in POD‐combined ALA‐PDT than with single treatments.

Conclusion

Podophyllotoxin ‐combined ALA‐PDT effectively promoted cell death through several pathways in HeLa and SiHa cells. This combination might be a promising therapeutic strategy for the HR‐HPV infection.
Potassium ion channel gene family provides new insights into powdery mildew responses in Triticum aestivum
Authors: Hu Yifeng , Xia Pengliang , Niu Hongli , Wu Xingyang , Gong Shuangjun , Ma Dongfang , Li Yan
Published: November 2021

The chromosomal localization, gene structure, transmembrane proteins, and transcriptome of the wheat Shaker family genes were analysed. The expression patterns of wheat Shaker genes under different stresses were investigated using reverse transcription quantitative PCR (RT‐qPCR). The effect of potassium ion treatment on wheat disease severity caused by powdery mildew was evaluated. To further investigate whether wheat Shaker genes also have inhibitory effects on other pathogens, Nicotiana benthamiana transiently overexpressing Shaker genes was inoculated with Phytophthora infestans and the effects on P. infestans infection judged by leaf lesion diameter. A total of 25 Shaker genes were identified in wheat (TaShaker genes) and were classified into four groups based on phylogenetic analysis. Chromosome mapping results indicated that the 25 TaShaker genes were distributed on 14 chromosomes in wheat (2B, 4A, 4B, 4D, 5A, 5B, and 5D). Gene structure analysis revealed the untranslated region structures were missing in some TaShaker genes, with the number of introns ranging from 7 to 11. Protein transmembrane prediction analysis indicated that there were multiple TaShaker transmembrane proteins. The results of the RT‐qPCR analysis indicated that TaShaker genes were not only involved in regulating drought stress, but could also resist infection by Fusarium graminearum and powdery mildew. This study also found that spraying potassium ion solutions at the seedling stage could reduce the severity of powdery mildew infection in wheat. Moreover, transient overexpression of TaShaker5.1‐3A in N. benthamiana leaves could inhibit P. infestans infection.
Communication related to medication incidents—A concept analysis and literature review
Authors: Syyrilä Tiina , Vehviläinen‐Julkunen Katri , Manias Elizabeth , Bucknall Tracey , Härkänen Marja
Published: November 2021

Aims

(1) To identify and analyse the conceptual framework and operationalise the concept of communication issues related to medication incidents in hospital to facilitate the development of a future tool for measuring frequencies of the communication issues. (2) To determine how the concept is distinct from related concepts.

Design

Concept analysis.

Data sources

Twenty‐three articles from seven scientific databases covering the years 2010–2020 and two official documents.

Methods

Walker and Avant’s concept analysis method was used. That was started by a systematised literature review on 2 November 2020 using specified criteria. Two authors evaluated articles’ quality by Joanna Brigg's Institute's criteria. Literature review results were analysed deductive‐inductively; conceptual framework was developed and concept defined presenting case scenarios. EQUATOR’s standards were used in study reporting.

Results

A conceptual framework and the concept of ‘communication related to medication incidents in hospitals’ were defined, comprising six main attribute categories: (1) communication dyads involved in communication, (2) patients’ or professionals’ individual issues, (3) institutional, (4) contextual and process issues, (5) communication concerning medication prescriptions and (6) qualitative characteristics of communication. The categories consisted of 128 quantitatively measurable and 10 qualitative attributes describing communication issues. The concept is distinct from related concepts by collating fragmented communication issues into the same concept.

Conclusion

The 128‐item conceptual framework and the concept of communication related to medication incidents in hospitals were defined, as there was not one. The concept assembled parts of previous theories and fragmented information to one entity. The concept needs further condensing and validation to develop a tool for measuring communication issues.

Impact on medication safety

The conceptual framework can be used in practice and education as indicative rationale for reflection of current communication issues. The concept contributes to research by providing necessary grounding for tool development for measuring communication factors relating medication incidents.
Criminal Sounds–Primitive Sounds: Sensory Conflict and the Racialization of Urban Space in Cartagena (Colombia) and Madrid (Spain)
Authors: González‐Güeto Joy Helena
Published: November 2021

This study reexamines how the racial construction of body/place is closely related to symbolic processes in the ordering of the sensory experiences of working‐class and poor neighborhoods. Specifically, it considers the role played by soundscapes in the aforementioned relationships within Andean communities in Madrid (Spain), and Palenquera communities in Cartagena (Colombia). The analytical framework of this article aims to rework the contributions of the sensory turn in sociology, so as to connect them with key categories taken from Critical Race Studies. To fulfill the aims of this work, a sensuous ethnography was carried out, including in‐depth interviews with inhabitants of working‐class and poor neighborhoods and activists from antiracist organizations. At the same time, the analysis was carried out into the cities’ local newspapers. The application of these conceptual frameworks and methodologies led to one main conclusion: sensory conflict related to sound in these cities is a fundamental manifestation of the racialization of space. The working‐class and poor neighborhoods of Cartagena and Madrid do not reproduce hegemonic urban sensory models but instead resist them on a daily basis.
Automatic segmentation and melanoma detection based on color and texture features in dermoscopic images
Authors: Oukil S. , Kasmi R. , Mokrani K. , García‐Zapirain B.
Published: November 2021

Purpose

Melanoma is known as the most aggressive form of skin cancer and one of the fastest growing malignant tumors worldwide. Several computer‐aided diagnosis systems for melanoma have been proposed, still, the algorithms encounter difficulties in the early stage of lesions. This paper aims to discriminate melanoma and benign skin lesion in dermoscopic images.

Methods

The proposed algorithm is based on the color and texture of skin lesions by introducing a novel feature extraction technique. The algorithm uses an automatic segmentation based on k‐means generating a fairly accurate mask for each lesion. The feature extraction consists of the existing and novel color and texture attributes measuring how color and texture vary inside the lesion. To find the optimal results, all the attributes are extracted from lesions in five different color spaces (RGB, HSV, Lab, XYZ, and YCbCr) and used as the inputs for three classifiers (K nearest neighbors, support vector machine , and artificial neural network).

Results

The PH2 set is used to assess the performance of the proposed algorithm. The results of our algorithm are compared to the results of published articles that used the same dataset, and it shows that the proposed method outperforms the state of the art by attaining a sensitivity of 99.25%, specificity of 99.58%, and accuracy of 99.51%.

Conclusion

The final results show that the colors combined with texture are powerful and relevant attributes for melanoma detection and show improvement over the state of the art.
Current state and positive impact of hospital‐based blood donor centers in the United States
Authors: Jacquot Cyril , Mei Zhen , Khan Jenna , Dunbar Nancy , Delaney Meghan , Ziman Alyssa
Published: November 2021

Background

The COVID‐19 pandemic has brought tremendous challenges to the United States blood supply. Decreased collections have caused blood product shortages. The number of hospital‐based donor centers (HBDCs) has decreased in the past decades, but they provide important support to their hospital systems.

Materials/Methods

We identified 79 active HBDCs through an information request to the FDA. These centers were invited to participate in a survey about their activities, blood product collections, and perceived value.

Results

Thirty‐six centers responded (46% response rate). The centers represented a wide range of states and geographic settings. Whole blood collection was most common, but some respondents also prepared specialized products such as COVID‐19 convalescent plasma and pathogen‐reduced platelets. Positive impacts of HBDCs included inventory availability, cost‐effectiveness/savings, community outreach, supporting special patient populations, and collecting specialty products. All respondents anticipate at least stable operations, if not growth, in the future.

Conclusion

HBDCs continue to be valuable assets in addressing emerging patient transfusion needs. Their unique offerings are tailored to the populations their hospitals support, and demonstrate the value in having the collection infrastructure in place to rapidly respond to critical shortages. This survey provides benchmark data about a broad group of HBDCs including products prepared, inventory self‐sufficiency levels, and reasons for positive impact.
Comparison of 12‐Hour Biweekly Versus 6‐Hour Weekly Shifts on Fatigue in Student Nurses
Authors: Grewal Alena , Holt Karyn E.
Published: November 2021

Background

Some challenges affecting student nurse learning include student fatigue, clinical recovery time, and hindered clinical experiences due to students experiencing long clinical shifts.

Aim

The aim of this study was to evaluate the differences between 12‐hour biweekly and 6‐hour weekly shifts on student nurse fatigue.

Methods

A descriptive research design was used with second‐year nursing students (N = 80) upon completion of their clinical rotations of four distinct cohorts during 2019–2020. All students in these cohorts were invited to complete the Occupational Fatigue Exhaustion Recovery (OFER15) online survey, developed and validated to assess the full spectrum of fatigue.

Results

There were no statistically significant differences in acute fatigue, chronic fatigue, or the inter‐shift recovery subscale for the 6‐hour and 12‐hour clinical groups. Student nurses, like registered nurses, would likely prefer to choose between a 6‐hour and 12‐hour clinical shift depending on their individual circumstances. In the parameters of this study, there was no statistical significance in shift length and student nurse fatigue.

Linking Evidence to Action

Student nurse fatigue levels can affect learning inside and outside of nursing clinical experiences. In this study, no statistical significances were found between 6‐hour and 12‐hour clinical experiences in second‐year nursing students. Offering both the 6‐hour and 12‐hour clinical experiences provides flexibility for students, clinical sites, and the school of nursing.
Association of CLABSI With Hospital Length of Stay, Readmission Rates, and Mortality: A Retrospective Review
Authors: Chovanec Kelli , Arsene Camelia , Gomez Cheryl , Brixey Molly , Tolles Diana , Galliers Jennifer Wheaton , Kopaniasz Renee , Bobash Tiffany , Goodwin Lamar
Published: November 2021

Background

An evidence‐based practice (EBP) approach to implementing change is relevant and pertinent to the strategy to improve outcomes for hospitalized patients with central venous catheters (CVC). As health systems endeavor to achieve the ambitious goals of improving the patient experience of care, improving the health of populations, and reducing the cost of health care, it is imperative to understand the impact of a central line‐associated bloodstream infection (CLABSI) on outcomes.

Aims

The purpose of the study was to contribute to the evidence of the association of CLABSI with the outcomes of hospital length of stay (LOS), readmission rates, and mortality rates for hospitalized patients.

Methods

A retrospective study was conducted, including all hospitalized patients with a CVC within four hospitals in an integrated health system in northwest Ohio and southeast Michigan. The sample population was stratified into two groups, CLABSI and no CLABSI, and the outcomes of interest for each group were compared.

Results

The findings substantiate the association between CLABSI and the hospital mortality rate, LOS, and readmission. Patients with a CVC who develop a CLABSI were 36.6% more likely to die in the hospital and 37.0% more likely to be readmitted compared with patients with a CVC who did not develop a CLABSI. In addition, hospital LOS increased an average of 2 days compared with patients without CLABSI. This study evokes implications for EBP change to reduce the rate of CLABSI and for quality improvement during in‐hospital care.

Linking Evidence to Action

There is an association between CLABSI and hospital mortality rate, LOS, and 30‐day readmission outcomes, presenting a profound sense of urgency for EBP change. There were potential variances in processes or practice relative to insertion, maintenance, and removal in the hospitals studied, representing an opportunity to examine the best practices in the hospitals that are performing well. Implementation of EBP requires selecting effective and innovative strategies, with a focus on stakeholder involvement and needs.
Mathematical Modeling of Extraction of Neodymium using Pseudo-emulsion based Hollow Fiber Strip Dispersion (PEHFSD)
Authors: L. Mishra Prateek , Swain Biswajit , Pabby Anil Kumar , Singh M. L. , Gulati S. , Ramasubramanium S.
Published: November 2021

Pseudo-emulsion based hollow fiber strip dispersion (PEHFSD) is a promising alternative technique due to its stability, simplicity and cost of operation. This is an efficient process due to its high surface area for extraction as well as stripping, and low energy consumption for creating the pseudo-emulsion and for the separation of phases. This technique takes the combine advantages of emulsion liquid membrane and overcomes the sufferings of membrane stability in the supported liquid membrane systems. Present work includes extraction of neodymium (III) (Nd) by using TODGA and HNO3 as the extractant cum strippant in PEHFSD technique. A model is developed to study the transport of Nd under different hydrodynamic and chemical conditions that includes organic ratio (A/O) in dispersion, effect of speed of impeller on drop size formation, effect of feed acidity, effect of carrier concentration, effect of feed flow rate. A code is written to solve the model equations numerically to predict the concentration of the feed reservoir with time. Experiments are conducted to obtain the best optimum extraction conditions. Results obtained from the numerical simulations are validated with the experimental data and found a good agreement between them.
Analysis of Averaging Methods for Nonuniform Total Pressure Fields
Authors: Burdett Daniel , Povey Thomas
Published: November 2021

A common objective in the analysis of turbomachinery components (nozzle guide vanes (NGVs) or rotor blades, for example) is to calculate performance parameters, such as total pressure or kinetic energy (KE) loss coefficients, from measurements in a nonuniform flow-field. These performance parameters can be represented in a range of ways. For example, line-averages used to compare performance between different radial sections of a 3D component; plane-averages used to assess flow (perhaps loss coefficient) development between different axial planes; and fully mixed-out values used to determine the total loss associated with a component. In the literature, the weighting method used for line- and plane-averaging (e.g., area, volume flow, mass flow, or entropy-flux) is sometimes regarded as an unimportant issue. Indeed, many authors neglect to even state which weighting method was used in their work. In certain low-speed test cases, or where measurements are made a long distance from the component, the nonuniformity in the flow will be relatively small and the practical difference between different weighting methods may be negligible. However, in high-speed applications or for measurements close to a component trailing edge, this becomes increasingly unlikely. In this paper, we compare a range of methods for calculating aerodynamic performance parameters—for example, the kinetic energy loss coefficient—including plane-average methods with different weighting schemes and several mixed-out methods. We analyze the sensitivities of the different methods to the axial location of the measurement plane, the radial averaging range, and the exit Mach number. We use high-fidelity experimental data taken in several axial planes downstream of a cascade of engine parts: high-pressure (HP) turbine NGVs operating at transonic Mach number. The experimental data are complemented by computational fluid dynamics (CFD). We discuss the underlying physical mechanisms which give rise to the observed sensitivities. The objective is to provide guidance on the accuracy of each method in a relevant, practical application.
The Imitation Game in Children With Tourette Syndrome: A Lack of Impulse Control to Mirror Environmental Stimuli
Authors: Briguglio Matteo , Galentino Roberta , De Michele Sara , Dell’Osso Bernardo , Fogassi Leonardo , Porta Mauro
Published: November 2021

The learning process in humans requires continuous contacts with environmental stimuli, especially during neurodevelopmental growth. These functions are assisted by the coding potential of mirror neurons to serve social interactions. This ability to learn imitating the observed behavior is no longer necessary during adulthood, and control mechanisms prevent automatic mirroring. However, children with Gilles de la Tourette syndrome could encounter coding errors at the level of the mirror neurons system as these cortical regions are themselves the ones affected in the syndrome. Combined with impulsivity, the resulting sign would be a manifest echopraxia that persists throughout adulthood, averting these individuals from the appraisal of a spot-on motor control.
Real-World Performance of Susceptibility Testing for Ceftolozane/Tazobactam against Non-Carbapenemase-Producing Carbapenem-Resistant Pseudomonas aeruginosa
Authors: Rivas Lina , Alcalde-Rico Manuel , Martínez José R. W. , Moreno María Victoria , Rojas Pamela , Wozniak Aniela , García Patricia , Olivares-Pacheco Jorge , Miller William R. , Arias Cesar A. , Khan Ayesha , Munita José M.
Published: November 2021

Ceftolozane/tazbactam (C/T) is a potent anti-pseudomonal agent that has clinical utility against infections caused by non-carbapenemase, producing-carbapenem-resistant
Pseudomonas aeruginosa
(non-CP-CR-PA). Accurate, precise, and reliable antimicrobial susceptibility testing (AST) is crucial to guide clinical decisions.
A New Pharmacokinetic-Pharmacodynamic Model To Characterize the Inoculum Effect of Acinetobacter baumannii on Polymyxin B
In Vitro
Authors: Akrong Grace , Chauzy Alexia , Aranzana-Climent Vincent , Lacroix Mathilde , Deroche Luc , Prouvensier Laure , Buyck Julien M. , Couet William , Marchand Sandrine
Published: November 2021

The inoculum effect (i.e., reduction in antimicrobial activity at large starting inoculum) is a phenomenon described for various pathogens. Given that limited data exist regarding inoculum effect of
Acinetobacter baumannii
, we evaluated killing of
A. baumannii
by polymyxin B, a last-resort antibiotic, at several starting inocula and developed a PKPD model to capture this phenomenon.
In vitro
static time-kill experiments were performed using polymyxin B at concentrations ranging from 0.125 to 128 mg/L against a clinical
A. baumannii
isolate at four starting inocula from 10
5
to 10
8
CFU/mL.
Emergence of the
cfr
Gene in Vibrio diabolicus of Seafood Origin
Authors: Liu Ming , Zhang Wenhui , Hu Yifan , Chen Pengyu , Wang Zhiqiang , Li Ruichao
Published: November 2021

The emergence and transmission of multidrug resistance (MDR) gene
cfr
have incurred great public health concerns worldwide. Recently, Gram-negative pathogens were found to carry
cfr
by various mobile elements. Here, we investigated a
cfr
-positive
Vibrio diabolicus
isolate by phenotyping and genomic analysis and found
cfr
in a translocatable structure (IS
26
-
hp
-
cfr
-IS
26
) among the MDR region in pNV27-cfr-208K, an emerging MDR plasmid in
Vibrio
species.
Incomplete Recruitment of Protective T Cells Is Associated with Trypanosoma cruzi Persistence in the Mouse Colon
Authors: Ward Alexander I. , Lewis Michael D. , Taylor Martin C. , Kelly John M.
Published: November 2021

Trypanosoma cruzi
is the etiological agent of Chagas disease. Following T cell-mediated suppression of acute-phase infection, this intracellular eukaryotic pathogen persists long-term in a limited subset of tissues at extremely low levels.
CC16 Deficiency in the Context of Early-Life
Mycoplasma pneumoniae
Infection Results in Augmented Airway Responses in Adult Mice
Authors: Iannuzo Natalie , Insel Michael , Marshall Craig , Pederson William P. , Addison Kenneth J. , Polverino Francesca , Guerra Stefano , Ledford Julie G.
Published: November 2021

Studies have shown that club cell secretory protein (CC16) plays important protective roles in the lungs, yet its complete biological functions are unclear. We devised a translational mouse model in order to investigate the impact of early life infections, in the context of CC16 deficiency, on lung function in adult mice.
Dispersed Carbon in Basalts of the Altered Oceanic Crust: Isotope Composition and Mechanisms of Formation
Authors: Polyakov V. B. , Shilobreeva S. N.
Published: November 2021

Carbon contents and isotopic compositions were compared in the basalt groundmass of the oceanic crust of different age in the zone of the East Pacific Rise. In samples the basalt groundmass of the ancient oceanic crust (~270 Ma, ODP Site 801C) in which a carbonate phase was found, the isotopic composition of the oxidized carbon (δ13C = ±1.5‰) indicates that this carbon was formed by the precipitation of seawater dissolved inorganic carbon (DIC). In the samples in which no carbonate phase was identified, the low concentration (<0.1 wt % CO2) of oxidized dispersed carbon and its isotopic composition (δ13C < –7‰) are in the range of values typical of carbon dissolved in basalt glasses without crystallinity. This makes it possible to relate the oxidized dispersed carbon to residual carbon dissolved in the magmatic melt after CO2degassing. The precipitation of DIC results in a positive correlation between the concentration of total carbon and its δ13C values, along with the formation of a carbonate phase. The application of this criterion to basalt groundmass samples of the young crust (~15 Ma, ODP Site 1256D) showed that oxidized dispersed carbon in the young oceanic crust groundmass was not formed by the precipitation of DIC, contradicting the generally accepted paradigm. Constant concentration and δ13C values of the reduced dispersed carbon in the basalt groundmass of the young and ancient oceanic crusts, including lithological zones where microbial activity has not been recorded, indicate that the most probable model is high-temperature abiogenic generation of reduced dispersed carbon near the ridge axis. The Fischer–Tropsch synthesis and/or Bell–Boudouard reaction provide a possible basis for the abiogenic model. The Bell–Boudouard reaction 2CO = C + CO2leads to the formation of an adsorbed layer of elemental carbon on the fresh surfaces of minerals during background alteration of the oceanic basalt crust. The CO2–CO gas-phase equilibrium maintains the necessary depletion of the newly formed elemental carbon in the13C isotope to δ13C < –20‰. Abiogenic models for the origin of the isotopically light reduced dispersed carbon in the basalt groundmass do not assume the presence of carbon depleted in the heavy13C isotope in the magmatic melt.
Primary high-grade diffuse large B-cell lymphoma of the glans penis
Authors: Fenech Marylou , Pisani David , Camilleri David James
Published: November 2021

Diffuse large B-cell lymphoma (DLBCL) of the penis is a rare haematological malignancy, with less than 30 cases being reported in the literature. Our case mentions a 57-year-old man who presented with a penile lesion that was diagnosed as DLBCL on histological biopsy. Targeted investigation and proper diagnosis are essential to distinguish it from squamous cell carcinoma (SCC) of the glans, which presents similarly. Since guidelines are not available, the author compared different management mentioned in case reports and the outcome was noted. Chemotherapy, radiotherapy and surgery were the treatment modalities most used; out of which, chemotherapy had the most successful outcome. On the other hand, surgery is the preferred modality in SCC of the penis. This further consolidates the need for guidelines with regard to proper diagnosis and management of this malignancy.
Isolated proximal weakness of the legs due to neuroborreliosis
Authors: Nibourg Simone , Beudel Martijn , Trip Jeroen
Published: November 2021

Proximal muscle weakness of the legs is a symptom with a broad differential diagnosis. It is mainly caused by neuromuscular disorders and is often a diagnostic challenge. Here, we present a 73-year-old man with isolated proximal weakness of the legs due to lumbar root involvement on the basis of neuroborreliosis. After treatment with intravenous antibiotics he recovered completely. This is the first described case with isolated proximal muscle weakness of the legs due to neuroborreliosis. Despite the fact neuroborreliosis is a rare cause of proximal muscle weakness of the legs, clinicians should include it in their differential diagnosis, especially since it is a treatable condition.
A model for self-management of chronic filarial lymphoedema with acute dermato-lymphangio-adenitis
Authors: Shetye Jaimala Vijay , Jain Anjali Suresh , Kachpile Sheral Thomas , Patil Ekta Nitin
Published: November 2021

Secondary lymphoedema due to filariasis is a leading cause of morbidity in India. We present a case of a 54-year-old female with lymphatic filariasis for 18 years, with three to four episodes of acute dermato-lymphangio-adenitis (ADLA) every year. The patient had voluntarily restricted social interaction and community participation. A combination of interventions provided in 17 physiotherapy sessions over a period of 20 days showed notable improvement, by reducing limb volume and ADLA episodes and by improving limb shape, functional capacity and quality of life. Interventions included aerobic exercise, decongestion therapy with faradism under pressure and exercises with elevation. This gain was maintained throughout the 8 months of the pandemic. Patient education and counselling along with home programme of self-bandaging and self-limb hygiene played a major role in the recovery of the patient. Self-reliance in management was important because of the pandemic, which restricted the patient from attending the outpatient department.
Integrating ultrasound with the combined spinal-epidural kit as a rescue technique during difficult spinal anaesthesia
Authors: Stagg Phil
Published: November 2021

Conducting spinal anaesthesia in patients with elevated body mass index is commonly difficult, yet there are no guidelines to direct best practice. Landmark techniques are sometimes insufficient, leading to increased failure rates and suboptimal patient outcomes. Although ultrasound-guided techniques are now considered standard care for central venous access and regional anaesthesia, there has been relatively sparse uptake of this widely available resource for central neuraxial block, despite evidence of its efficacy.

This article outlines a successful case of ultrasound-assisted spinal anaesthesia, after landmark techniques failed, in conjunction with a combined spinal-epidural kit. This unique combination of techniques has not been published as an amalgamated rescue strategy for difficult spinal anaesthesia. This article adds to current evidence by highlighting the potential benefits of combining these techniques into a novel approach either when difficulties are expected or as a rescue technique after failed landmark-based attempts.
Deletion of GPR21 improves glucose homeostasis and inhibits the CCL2-CCR2 axis by divergent mechanisms
Authors: Riddy Darren M , Kammoun Helene L , Murphy Andrew J , Bosnyak-Gladovic Sanja , De la Fuente Gonzalez Rocio , Merlin Jon , Ziemann Mark , Fabb Stewart , Pierce Tracie L , Diepenhorst Natalie , Rueda Patricia , El-Osta Assam , Gautier Jean-Francois , Venteclef Nicolas , Charman William N , Christopoulos Arthur , Sexton Patrick M , Summers Roger J , Febbraio Mark A , Delerive Philippe , Langmead Christopher J
Published: November 2021

Introduction

A potential role for the orphan G protein-coupled receptor, GPR21, in linking immune cell infiltration into tissues and obesity-induced insulin resistance has been proposed, although limited studies in mice are complicated by non-selective deletion ofGpr21.

Research design and methods

We hypothesized that aGpr21-selective knockout mouse model, coupled with type 2 diabetes patient samples, would clarify these issues and enable clear assessment of GPR21 as a potential therapeutic target.

Results

High-fat feeding studies inGpr21−/−mice revealed improved glucose tolerance and modest changes in inflammatory gene expression.Gpr21−/−monocytes and intraperitoneal macrophages had selectively impaired chemotactic responses to monocyte chemoattractant protein (MCP)-1, despite unaltered expression ofCcr2. Further genotypic analysis revealed that chemotactic impairment was due to dysregulated monocyte polarization. Patient samples revealed elevatedGPR21expression in peripheral blood mononuclear cells in type 2 diabetes, which was correlated with both %HbA1c and fasting plasma glucose levels.

Conclusions

Collectively, human and mouse data suggest that GPR21 influences both glucose homeostasis and MCP-1/CCL2-CCR2-driven monocyte migration. However, aGpr21−/−bone marrow transplantation and high-fat feeding study in mice revealed no effect on glucose homeostasis, suggesting that there is no (or limited) overlap in the mechanism involved for monocyte-driven inflammation and glucose homeostasis.
Type 2 diabetes and the risk of cardiovascular events in peripheral artery disease versus coronary artery disease
Authors: Sprenger Lukas , Mader Arthur , Larcher Barbara , Mächler Maximilian , Vonbank Alexander , Zanolin-Purin Daniela , Leiherer Andreas , Muendlein Axel , Drexel Heinz , Saely Christoph H
Published: November 2021

Introduction

The prevalence of type 2 diabetes mellitus (T2DM) is higher in peripheral artery disease (PAD) than in coronary artery disease (CAD) patients, and PAD overall confers higher cardiovascular risk than CAD. How cardiovascular risk compares between PAD and CAD patients when analyses are stratified by the presence of type 2 diabetes is unclear and is addressed in the present study.

Research design and methods

We prospectively recorded major cardiovascular events (MACE; ie, cardiovascular death, myocardial infarction or stroke) over 10.0±4.7 years in 923 patients with stable CAD, of whom 26.7% had T2DM and in 292 patients with PAD, of whom 42.1% had T2DM. Four groups were analyzed: CAD patients without diabetes (CAD/T2DM−; n=677), CAD patients with T2DM (CAD/T2DM+; n=246), PAD patients without diabetes (PAD/T2DM−; n=169) and PAD patients with T2DM (PAD/T2DM+; n=123).

Results

The event rate for MACE increased over our four investigated groups: it was lowest in CAD/T2DM− patients (2.52 events per 100 person-years). It was significantly higher in CAD/T2DM+ patients (3.96 events per 100 person-years; p<0.001), in PAD/T2DM− patients (3.68 events per 100 person-years; p=0.022), and in PAD/T2DM+ patients (7.10 events per 100 person-years; p<0.001), who in turn were at a higher risk than CAD/T2DM+ or PAD/T2DM− patients (p=0.001 and p<0.001, respectively). Cox regression analysis after multivariate adjustment showed that the presence of T2DM (HR=1.44 (95% CI 1.09 to 1.92); p=0.012) and the presence of PAD versus CAD (HR=1.48 (95% CI 1.15 to 1.91); p=0.002) were mutually independent predictors of cardiovascular events.

Conclusions

In conclusion, our data show that T2DM as well as the presence of PAD versus CAD are mutually independent predictors of MACE. Patients with both PAD and T2DM are at an exceedingly high risk of cardiovascular events.
Validation and feasibility of a postal system for remote monitoring of HbA1c
Authors: Cross Jen , Sharma Sanjeev , John W Garry , Rayman Gerry
Published: November 2021

Introduction

The COVID-19 pandemic has reduced the accessibility to hemoglobin A1c (HbA1c) tests required for virtual diabetes clinics. The aim was to develop and validate a user-friendly postal system for remote HbA1c monitoring.

Research design and methods

Validation: A total of 123 capillary blood samples from people with diabetes (PWD) needing face-to-face consultations along with healthy volunteers were measured on a point-of-care (POC) Siemens DCA Vantage Analyzer. Another sample of 5–10 drops was simultaneously collected in a K2EDTA tube (BD Microtainer) and stored for up to 12 days at room temperature for subsequent retesting. Feasibility: During October to December 2020, a total of 286 postal HbA1c kits were sent to PWD prior to their virtual consultation. These contained sample collection guidance, the necessary equipment and a feedback form. As per Packing Instruction 650 regulations, these were posted back to the diabetes center for HbA1c testing on the POC analyzer.

Results

There was a strong correlation between the first and the stored sample (R2=0.978). There was a small clinically insignificant negative bias −1.53 mmol/mol (2 SD = 3.10 mmol/mol). Bland-Altman plots showed 93% of results within 2 SD. Of the 87% of returned kits, only one sample failed to be analyzed. 94% of PWD who provided feedback were happy to use the postal HbA1c system again.

Conclusions

A robust user-friendly postal HbA1c system has been created and successfully integrated into clinical practice using the existing POC equipment at the diabetes center. It provides accurate HbA1c results and is an invaluable tool for remote monitoring of HbA1c in PWD—both during and after the pandemic.
Availability of population-level data sources for tracking the incidence of deaths and injuries from road traffic crashes in low-income and middle-income countries
Authors: Mitra Sudeshna , Neki Kazuyuki , Mbugua Leah Watetu , Gutierrez Hialy , Bakdash Leen , Winer Mercer , Balasubramaniyan Ramshankar , Roberts Jaeda , Vos Theo , Hamilton Erin , Naghavi Mohsen , Harrison James E , Job R F Soames , Bhalla Kavi
Published: November 2021

Introduction

Tracking progress towards Sustainable Development Goal (SDG) 3·6 of reducing traffic deaths and serious injuries poses a measurement challenge in most low-income and middle-income countries (LMICs) due to large discrepancies between reported official statistics and estimates from global health measurement studies. We assess the extent to which national population censuses and health surveys can fill the information gaps.

Methods

We reviewed questionnaires for nationally representative surveys and censuses conducted since 2000 in LMICs. We identified sources that provide estimates of household ownership of vehicles, incidence of traffic deaths and non-fatal injuries, and prevalence of disability.

Results

We identified 802 data sources from 132 LMICs. Sub-Saharan African countries accounted for 43% of all measurements. The number of measurements since 2000 was high, with 97% of the current global LMIC population having at least one measurement for vehicle ownership, 77% for deaths, 90% for non-fatal injuries and 50% for disability due to traffic injuries. Recent data (since 2010) on traffic injuries were available from far fewer countries (deaths: 21 countries; non-fatal injuries: 62 and disability: 12). However, there were many more countries with recent data on less-specific questions about unintentional or all injuries (deaths: 41 countries, non-fatal: 87, disability: 32).

Conclusion

Traffic injuries are substantially underreported in official statistics of most LMICs. National surveys and censuses provide a viable alternative information source, but despite a large increase in their use to monitor SDGs, traffic injury measurements have not increased. We show that relatively small modifications and additions to questions in forthcoming surveys can provide countries with a way to benchmark their existing surveillance systems and result in a substantial increase in data for tracking road traffic injuries globally.
Multimorbidity patterns of chronic conditions and geriatric syndromes in older patients from the MoPIM multicentre cohort study
Authors: Baré Marisa , Herranz Susana , Roso-Llorach Albert , Jordana Rosa , Violán Concepción , Lleal Marina , Roura-Poch Pere , Arellano Marta , Estrada Rafael , Nazco Gloria Julia
Published: November 2021

Objectives

To estimate the frequency of chronic conditions and geriatric syndromes in older patients admitted to hospital because of an exacerbation of their chronic conditions, and to identify multimorbidity clusters in these patients.

Design

Multicentre, prospective cohort study.

Setting

Internal medicine or geriatric services of five general teaching hospitals in Spain.

Participants

740 patients aged 65 and older, hospitalised because of an exacerbation of their chronic conditions between September 2016 and December 2018.

Primary and secondary outcome measures

Active chronic conditions and geriatric syndromes (including risk factors) of the patient, a score about clinical management of chronic conditions during admission, and destination at discharge were collected, among other variables. Multimorbidity patterns were identified using fuzzy c-means cluster analysis, taking into account the clinical management score. Prevalence, observed/expected ratio and exclusivity of each chronic condition and geriatric syndrome were calculated for each cluster, and the final solution was approved after clinical revision and discussion among the research team.

Results

740 patients were included (mean age 84.12 years, SD 7.01; 53.24% female). Almost all patients had two or more chronic conditions (98.65%; 95% CI 98.23% to 99.07%), the most frequent were hypertension (81.49%, 95% CI 78.53% to 84.12%) and heart failure (59.86%, 95% CI 56.29% to 63.34%). The most prevalent geriatric syndrome was polypharmacy (79.86%, 95% CI 76.82% to 82.60%). Four statistically and clinically significant multimorbidity clusters were identified: osteoarticular, psychogeriatric, cardiorespiratory and minor chronic disease. Patient-level variables such as sex, Barthel Index, number of chronic conditions or geriatric syndromes, chronic disease exacerbation 3 months prior to admission or destination at discharge differed between clusters.

Conclusions

In older patients admitted to hospital because of the exacerbation of chronic health problems, it is possible to define multimorbidity clusters using soft clustering techniques. These clusters are clinically relevant and could be the basis to reorganise healthcare circuits or processes to tackle the increasing number of older, multimorbid patients.

Trial registration number

NCT02830425.
Prospective pilot study protocol evaluating the safety and feasibility of robot-assisted nipple-sparing mastectomy (RNSM)
Authors: Park Ko Un , Lee Sandy , Sarna Angela , Chetta Matthew , Schulz Steven , Agnese Doreen , Grignol Valerie , Carson William E , Skoracki Roman J
Published: November 2021

Introduction

Nipple-sparing mastectomy (NSM) can be performed for the treatment of breast cancer and risk reduction, but total mammary glandular excision in NSM can be technically challenging. Minimally invasive robot-assisted NSM (RNSM) has the potential to improve the ergonomic challenges of open NSM. Recent studies in RNSM demonstrate the feasibility and safety of the procedure, but this technique is still novel in the USA.

Methods and analysis

This is a single-arm prospective pilot study to determine the safety, efficacy and potential risks of RNSM. Up to 12 RNSM will be performed to assess the safety and feasibility of the procedure. Routine follow-up visits and study assessments will occur at 14 days, 30 days, 6 weeks, 6 months and 12 months. The primary outcome is to assess the feasibility of removing the breast gland en bloc using the RNSM technique. To assess safety, postoperative complication information will be collected. Secondary outcomes include defining benefits and challenges of RNSM for both surgeons and patients using surveys, as well as defining the breast and nipple-areolar complex sensation recovery following RNSM. Mainly, descriptive analysis will be used to report the findings.

Ethics and dissemination

The RNSM protocol was reviewed and approved by the US Food and Drug Administration using the Investigational Device Exemption mechanism (reference number G200096). In addition, the protocol was registered with ClinicalTrials.gov (NCT04537312) and approved by The Ohio State University Institutional Review Board, reference number 2020C0094 (18 August 2020). The results of this study will be distributed through peer-reviewed journals and presented at surgical conferences.

Trial registration number

NCT04537312.
Which outcomes are most important to measure in patients with COVID-19 and how and when should these be measured? Development of an international standard set of outcomes measures for clinical use in patients with COVID-19: a report of the International Consortium for Health Outcomes Measurement (ICHOM) COVID-19 Working Group
Authors: Seligman William H , Fialho Luz , Sillett Nick , Nielsen Christina , Baloch Farhala M , Collis Philip , Demedts Ingel K M , Fleck Marcelo P , Floriani Maiara A , Gabriel Lucinda E K , Gagnier Joel J , Keetharuth Anju , Londral Ana , Ludwig Ingvar I L , Lumbreras Carlos , Moscoso Daza Alejandro , Muhammad Nasreen , Nader Bastos Gisele A , Owen Christine W , Powers John H , Russell Anne-Marie , Smith Michaela K , Wang Tracy Y-P , Wong Evan K , Woodhouse Douglas C , Zimlichman Eyal , Brinkman Kees
Published: November 2021

Objectives

The COVID-19 pandemic has resulted in widespread morbidity and mortality with the consequences expected to be felt for many years. Significant variation exists in the care even of similar patients with COVID-19, including treatment practices within and between institutions. Outcome measures vary among clinical trials on the same therapies. Understanding which therapies are of most value is not possible unless consensus can be reached on which outcomes are most important to measure. Furthermore, consensus on the most important outcomes may enable patients to monitor and track their care, and may help providers to improve the care they offer through quality improvement. To develop a standardised minimum set of outcomes for clinical care, the International Consortium for Health Outcomes Measurement (ICHOM) assembled a working group (WG) of 28 volunteers, including health professionals, patients and patient representatives.

Design

A list of outcomes important to patients and professionals was generated from a systematic review of the published literature using the MEDLINE database, from review of outcomes being measured in ongoing clinical trials, from a survey distributed to patients and patient networks, and from previously published ICHOM standard sets in other disease areas. Using an online-modified Delphi process, the WG selected outcomes of greatest importance.

Results

The outcomes considered by the WG to be most important were selected and categorised into five domains: (1) functional status and quality of life, (2) mental functioning, (3) social functioning, (4) clinical outcomes and (5) symptoms. The WG identified demographic and clinical variables for use as case-mix risk adjusters. These included baseline demographics, clinical factors and treatment-related factors.

Conclusion

Implementation of these consensus recommendations could help institutions to monitor, compare and improve the quality and delivery of care to patients with COVID-19. Their consistent definition and collection could also broaden the implementation of more patient-centric clinical outcomes research.
Advance care planning and health literacy in older dialysis patients: qualitative interview study
Authors: O Riordan Julien , Kane P M , Noble Helen , Smyth Andrew
Published: November 2021

Objectives

Low health literacy among older adults is associated with limited engagement in end-of-life care planning, higher hospitalisation rates and increased mortality. Frequently, older dialysis patients derive no survival benefit from dialysis and their quality of life often deteriorates further on dialysis. Older dialysis patients’ values and wishes are frequently unknown during key healthcare decision making and many endure medically intensive end-of-life scenarios. The objectives of this study were to explore older dialysis patients’ understanding of haemodialysis, to explore their engagement in end-of-life care planning and to explore their satisfaction with life on haemodialysis.

Methods

15 older dialysis patients participated in qualitative semistructured interviews in two haemodialysis units in Ireland. Thematic saturation was reached. Thematic analysis, applied inductively, was used to distill the data.

Results

Themes identified included disempowerment among participants reflected limited health literacy, poor advance care planning compromised participant well-being, haemodialysis compromised participants’ core values.

Conclusion

Health literacy levels among older dialysis patients are poor, patient empowerment is limited and their participation in shared decision making and advance care planning is suboptimal. Consequently, healthcare decision making, including haemodialysis, may jeopardise patients’ core values. Improving health literacy through enhanced patient education and improved communication skills training for clinicians is necessary to promote patient participation in shared decision making. Clinician training to facilitate discussion of patients’ values and wishes will help guide clinicians and patients towards healthcare decisions most concordant with patients’ core values. This approach will optimise the circumstances for patient-centred care.