Interleukine6 in really ill COVID19 people A retrospective investigation

The new coronavirus disease's (COVID-19) high risk of infection can increase the workload of healthcare workers, especially nurses, as they are most of the healthcare workforce. These problems can lead to psychological problems. Therefore, the aim of this systematic review and meta-analysis to ascertain the present impact of the COVID-19 outbreak on the prevalence of stress, anxiety, depression and sleep disturbance among nurses.
A systematic review and meta-analysis were conducted. The following databases were searched PubMed, CHINAL, MEDLINE, EMBASE, PsycINFO, MedRxiv and Google Scholar, from January 2020 up to 26th October 2020. Prevalence rates were pooled with meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I
) statistics.
A total of 93 studies (n=93,112), published between January 2020 and September 2020, met the inclusion criteria. The overall prevalence of stress was assessed in 40 studies which accounted for 43% (95% CI 37-49). The pooled prevalence of anxtudy is needed to distinguish of psychological symptoms during and after the infectious disease outbreaks.
Rhabdomyosarcoma (RMS) is a highly malignant soft tissue sarcoma (STS), usually of adults, displaying skeletal muscle differentiation. STS principally metastasize to the lungs with more than 50% of metastatic patients presenting with isolated pulmonary metastasis. Paradoxically, the majority of drugs prescribed to treat RMS are associated with multidrug resistance.
We report the case of a 53 year-old patient who developed three synchronous chemoresistant lung metastasis from pleomorphic RMS. Considering the poor prognosis, the patient's preference and the chemoresistance of her lung metastasis, we decided to perform two consecutive stereotactic body radiotherapy (SBRT) on two of these three lesions.
Initially, the patient was referred to our institute with a painful mass in the anterior part of the left thigh increasing in volume for 3 months. Biopsy revealed a high-grade pleomorphic RMS. The cancer being staged IB, she had neoadjuvant radiotherapy. After complete surgical excision, pathology examination revealed a 6cm Grade II pleomorphic RMS, with clear margins. Six months later, she developed three synchronous lung metastases. She got 4 courses of doxorubicin-ifosfamide which were poorly supported. After two courses, a heterogeneous (morphological and metabolic) response was observed, hence SBRT was delivered with a Biologically Equivalent Dose (α/β10)> 100 Gray on the two more chemoresistant lesions. This SBRT was very well tolerated, no side effects were reported. The patient remained alive and achieved a complete response of these three metastases, which sustains after more than 3 years.
Early recognition and proper management of these oligometastatic patients may lead to motivating results in a poor prognosis disease.
Early recognition and proper management of these oligometastatic patients may lead to motivating results in a poor prognosis disease.
Chemoradiation (CRT) with intensity modulated radiation treatment (IMRT) has become the standard for anal cancer. In patients who fail this treatment modality, salvage surgery with abdominal perineal resection can result in long term cancer control. We aimed to evaluate a single centre's experience of salvage surgery for local recurrence since the introduction of IMRT.
A retrospective chart review was performed of all patients who underwent definitive CRT for anal carcinoma at a single tertiary referral center since IMRT became standard in 2009. Patients with recurrent or persistent disease after treatment who underwent salvage surgery were included. Details of CRT, salvage surgery and surgical complications, patterns of recurrence after surgery, and survival data were collected and described.
Between 2009-2018, 181 patients underwent definitive treatment using IMRT for anal carcinoma. Of 26 patients who had locoregional recurrent or persistent disease, 14 underwent salvage surgery. Nine had multi-visceral resection and 8 required autologous flap reconstruction. Twelve patients had resections with clear margins and 2 had microscopic positive margins. Twelve patients (86%) experienced post-operative complications, and eight (57%) had perineal wound complications. After salvage, four patients (29%) recurred locally. None of the 8 patients with rpT2 disease recurred. After salvage surgery, 5-year disease free survival was 68.4% and 5-year overall survival was 75%.
Following IMRT based chemoradiation, salvage surgery has high rates of surgical complications; however disease free and overall survival results are excellent particularly for small recurrences.
Following IMRT based chemoradiation, salvage surgery has high rates of surgical complications; however disease free and overall survival results are excellent particularly for small recurrences.Aspirin is a commonly used medication with anti-inflammatory and analgesic properties, and it is widely used to reduce the risk of ischaemic heart disease-related events and/or cerebrovascular accidents. However, there is also evidence from epidemiological and interventional studies to suggest that regular aspirin use can reduce the risk of prostate cancer development and progression, and can reduce the risk of disease recurrence following anti-prostate cancer therapy. Aspirin use in African-American men is associated with a reduced incidence of advanced PCa and reduced disease recurrence, and there is evidence from other studies of an association between regular aspirin use and decreased PCa-related mortality. The cyclooxygenase-2 enzyme inhibited by Aspirin and other NSAIDs, and which catalyses prostaglandin synthesis and mediates inflammation, is overexpressed in prostate cancer, therefore inhibition of cyclooxygenase-2 may have direct, and indirect, therapeutic effects. This review explores the evidence suggesting that aspirin use can modify prostate cancer biology and disease characteristics, and explores the potential mechanisms underpinning the observed associations between aspirin use and modification of prostate cancer risk. It also summarises the potential for adjuvant aspirin use to combine with other therapeutic approaches such as radical surgery and radiotherapy.Extrahepatic disorders are recorded with hepatitis E virus (HEV) infection. The impact of HEV infection on the male reproductive system is a query. In this study, we retrospectively analyzed semen from infertile men and prospectively examined the semen from acute hepatitis E patients (AHE) for HEV markers. HEV RNA and HEV Ag were not detectable in the semen of infertile men nor the semen of AHE patients. Although HEV markers were detectable in the urine of patients infected with HEV-1, these markers were absent in their semen. There is no significant difference in the level of reproductive hormones between AHE patients and healthy controls. Semen analysis of AHE patients did not show a notable abnormality and there was no significant difference in the semen quality and sperm characteristics between AHE and healthy controls.The aim of our study was to investigate whether the experience of objects' implicit features would change if we observe it as a real 3D object or as a photograph or a drawing. In our experiment 46 participants estimated their impression of 10 objects shown in four different presentations. As stimuli, we used 3D objects, their virtual reality models, photographs and drawings from four different viewing directions, created by architecture students. As a measure of implicit features experience we used 12 bipolar adjectives grouped into four factors (attractiveness, regularity, arousal, and calmness) and 3 adjectives forming aesthetic experience factor. Results show significant differences between types of object presentations on four factors of implicit features experience, but not on the aesthetic experience factor. Real 3D objects were experienced as more attractive and calm, while VR presentation showed reduced arousal than other presentation types. On regularity VR and real 3D objects were experienced as same and more regular then drawings and photographs.The question whether human beings process empty sets as zero has received little research attention. In this study, we used the distance and end effects as indicators for treating empty sets as a numerical entity that represents an absence of quantity. In a series of experiments, participants performed a magnitude comparison task. They were presented with empty sets and other numerosities from 1 to 9, presented as dot arrays. We manipulated task instructions relevant to the target (i.e., "choose the target that contains more/less dots" in Experiment 1) or the given numerical range mentioned in the instructions (i.e., 0-9 or 1-9 in Experiment 2) to create conditions in which an empty set would be perceived as the smallest value of the experimental numerical range. The results revealed distance effects for comparisons to empty sets, irrespective of task instructions. In Experiment 3, we manipulated the response mode. Two groups of participants responded to target location, one group with a key-press and the other vocally, while the third group responded vocally to target color. The results revealed distance effects for comparisons to empty sets only when responding to target location, regardless of the response mode, indicating that spatial features should be primed in order to perceive an empty set as a numerical entity. These findings show that perceiving an empty set as nothing or as zero depends on the context in which it is presented.
The Idiopathic Inflammatory Myositis (IIM) are heterogenous with distinct clinical phenotypes associated with specific myositis specific antibodies (MSA) and myositis associated antibodies (MAA).
To evaluate the frequency, pattern and associations of MSA/MAA in a large Indian cohort of IIM.
Adult and juvenile IIM (2017 ACR/EULAR criteria), were recruited in the MyoCite cohort between 2017and 2020 at a tertiary center in Northern India. Standardized clinical and laboratory variables were extracted from the database archive. Serum samples were evaluated for the presence of MSAs/MAAs by Line immunoassay and anti-nuclear antibodies (ANA) by Immunofluorescence assay (IFA). The prevalence and clinical associations of different MSA/MAAs were assessed.
MSA and MAAs were tested in 250 IIM patients (214 adults, 36 children) of age [40 (30
49), 13 (7.5-16) years] and disease duration [ 7 (3-17), 6 (2-17) months] comprising predominantly of Dermatomyositis (DM) followed by Overlap myositis (OM). MSAs/MAAs were fMyositis autoantibodies are seen in two-thirds IIMs and are associated with distinct clinical subsets. Jo-1 and non-Jo-1 ASS exhibit similar characteristics. The association of anti-TIF1 γ with malignancy was confirmed in adults. MSA/MAA were present in two-thirds of those with negative ANA and MSA were nearly always mutually exclusive.
Myositis autoantibodies are seen in two-thirds IIMs and are associated with distinct clinical subsets. Jo-1 and non-Jo-1 ASS exhibit similar characteristics. The association of anti-TIF1 γ with malignancy was confirmed in adults. MSA/MAA were present in two-thirds of those with negative ANA and MSA were nearly always mutually exclusive.
Colchicine has been used historically as an anti-inflammatory agent for a wide range of diseases. Little is known regarding the relationship between colchicine use and infectious disease outcomes. The objective of this study was to systematically examine infectious adverse events associated with colchicine usage and the clinical use of colchicine for infectious diseases.
A systematic review was conducted in accordance with PRISMA methodology. PubMed, EMBASE, Scopus and Cochrane Library databases were searched (up to 12
October, 2020) for interventional and observational studies that included colchicine usage associated with infectious adverse events or infectious disease outcomes.
A total of 9,237 studies were initially identified and after exclusions, 36 articles comprising 21 interventional studies and 15 observational studies were included in this systematic review. There were 19 studies that reported infectious adverse events and 17 studies that examined the efficacy of colchicine in treating infet of COVID-19 but results from more clinical trials are needed. There is inconclusive evidence that suggests colchicine is associated with increased risk of infections, particularly pneumonia.
There is a current lack of clinical evidence that colchicine has a role in treating or managing infectious diseases. Preliminary studies have demonstrated a possible role in the management of COVID-19 but results from more clinical trials are needed. There is inconclusive evidence that suggests colchicine is associated with increased risk of infections, particularly pneumonia.A series of iminopyridine complexes of platinum(II), bearing a flexible diethereal, aryl terminated residue, where the size of aryl group is varied from phenyl to 9-anthracenyl, was synthesized. The new complexes are soluble and stable in DMSO/H2O mixtures. Besides the metal center, aryl groups are available for further interactions with DNA, due to the good side chain flexibility. The new aryl functionalized iminopyridine dichlorido platinum(II) complexes show a significant antiproliferative activity on ovarian carcinoma cells and notably, complex 13 is able to overcome cisplatin resistance. The study of the interaction mode of 13 with DNA highlighted the ability to form a molecular complex characterized by a dual (intercalative and groove binding) geometry. The complex is also able to covalently add to DNA even though interstrand cross-links appear significantly hampered with respect to cisplatin. The interactions with the macromolecule are discussed in view of the observed cell effect.Swine influenza viruses not only constitute a potential economic problem for livestock, but also pose a substantial threat to human health. Mutation in the proteolytic cleavage site of hemagglutinin (HA) is recognized as an essential factor of tissue tropism and viral pathogenicity. However, the molecular properties of the cleavage site of Eurasian avian-like swine (EA) H1N2 virus remain largely unknown. In this study, we found a serine-leucine (Ser-Leu) substitution at the P2 position of the HA cleavage site (S328 L) in naturally occurring EA H1N2 virus. To study the effect of this substitution, we used reverse genetics to generate recombinant wild-type and mutant viruses containing a single amino acid mutation at the P2 position in A/swine/Guangdong/YJ28/2014 (YJ28) or A/swine/Guangdong/DG2/2015 (DG2) background. In vitro experiments showed that the Ser-Leu substitution at the P2 position attenuated the viral replication and HA cleavage efficiency. In vivo analyses revealed that, while all mice inoculated with r/DG2-S328 L or r/YJ28 viruses survived, the survival rates of r/DG2- and r/YJ28-L328S-inoculated animals were 20 % and 40 %, respectively. Furthermore, the Ser-Leu substitution at the P2 position attenuated the replication in nasal turbinate and lungs. In summary, this amino acid change may be useful to understand the molecular properties of the cleavage site and be valuable for vaccine development.A robust and comprehensive infection control plan in a senior living community is a must. Delirium manifestations of Covid-19 and or Urinary Tract Infections, may be confused or misdiagnosed with dementia symptoms in memory care residents. A robust incontinence care program is a key pillar of infection control to reduce symptoms causing hospitalization. Misdiagnosis, transfer infections, acute treatment dementia challenges, worsening incontinence are all risks of residents being hospitalized. A comprehensive incontinence assessment, plan, and education program are all paramount to seeing a reduction in hospitalizations and misdiagnosis of Covid-19 and other symptoms.
Little is known regarding the transfer of bioscience knowledge gained during undergraduate nursing studies into clinical practice.
To explore the experiences of new registered nurses in applying bioscience concepts in their day-to-day nursing practice.
Descriptive qualitative design.
Fifteen recently graduated registered nurses (RNs) who were working in acute care settings participated in the study.
Semi-structured, face-to-face individual interviews were conducted. Interview data were audio-recorded and thematically analysed.
Four themes were identified from the qualitative interviews. The first and second themes demonstrated nurses' realisation of the relevance of theoretical bioscience knowledge learnt within the classroom to their practice and how this evidence-based knowledge translated into confidence in decisions made. The third and fourth themes revealed the impact bioscience knowledge had on RNs' relationships with patients and family members, which was viewed as providing compassionate cy to individual patient needs.
The investigation of affective awareness in nursing students is important insofar as the results can serve to improve the quality of education provided to them and enhance nursing undergraduate education programs.
This study aims to develop a valid and reliable measurement tool for use in determining and evaluating the hidden curriculum of institutions providing nursing education at the level of bachelor's degree.
University Faculty Nursing.
Nursing students.
This study was a methodological scale development study. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were conducted for the construct validity of the measurement tool of which content validity and a pilot study were conducted. For predictive validity, Pearson correlation coefficient between total scale and its subdimensions was calculated and the compliance between them was examined. Time invariance of the scale was tested using the test-retest method (test-retest reliability was estimated). Internal consistency relon's hidden curriculum. Formal program outcomes should correspond with each other to ensure nursing students' graduation outcomes as intended. This study in which a measurement tool was developed to determine and evaluate the hidden program in nursing education is thought to facilitate the process. The Hidden Curriculum Evaluation Scale in Nursing Education (HCES-N) is a measurement tool providing psychometric characteristics to be used in accordance with its purpose.
Registered nurses must have a level of scientific literacy to be able to interpret research data and access Scientific's knowledge. Several studies have been conducted to explore barriers and levers to the dissemination of nurse's knowledge; however, the scientific literacy that nursing students acquire has not been studied.
The aim was to examine and compare the way that research is taught to undergraduate nursing students in France and other countries.
Cross-sectional, Internet survey.
Universities providing undergraduate nursing programs around the world.
Nurses educators.
Schools of nursing and universities were contacted by mail, through social networks and with the help of national or international nursing organizations. Respondents provided demographic data on schools and faculties of nursing, the teaching of scientific databases, Reading Critical Analysis and the teaching of scientific English. Information on the transmission of articles and access to scientific knowledge by students throue the development of scientific literacy skills.
Our results show that most schools or universities of nursing teach the three majors' components to promote, provide articles to students and give access to scientific knowledge. However, there is wide heterogeneity between countries. There is a need to standardize research education for nursing students worldwide to promote the development of scientific literacy skills.
Nurses need resilience to safeguard their well-being. In collaboration with a military reservist organisation the Team Series was designed to foster resilience by promoting teamwork and leadership skills in student nurses.
To explore participants' experiences of engaging with the Team Series and the skills and knowledge acquired.
A qualitative design.
A Scottish University.
Fourteen 3rd year pre-registration nursing students, ten academic staff and ten reservists.
Audio-taped focus groups and interviews thematically analysed.
Students conceptualised resilience as clinical competence, valuing an active learning process enabling them to practice clinical and interpersonal skills, utilising a range of communication, team-building, leadership and problem-solving skills. Participation in the Team Series fostered self-awareness and self-confidence, the foundations of resilience, helping students feel more competent in coping effectively in stressful situations.
The positive impact of collaborating with a military organisation experienced in developing team-working and leadership skills is demonstrated. Learning experiences designed to promote physical and emotional resilience should be threaded throughout curricula to ensure these attributes are developed and sustained over time.
The positive impact of collaborating with a military organisation experienced in developing team-working and leadership skills is demonstrated. Learning experiences designed to promote physical and emotional resilience should be threaded throughout curricula to ensure these attributes are developed and sustained over time.
Developing clinical leaders is essential for high-quality, safe care for older people. Fundamental to achieving this is specialist continuing professional development for nurses and allied health professionals.
To investigate the motivations of nurses and allied health professionals to undertake a national specialist gerontological programme, the Older Persons Fellowship, and its impacts on their development and on older people care.
A qualitative descriptive design.
Participants were nurses and allied health professionals undertaking a national specialist gerontological programme in England. A purposive sample of 63 participants was recruited. Twelve focus groups and four individual interviews were conducted between February 2015 and February 2019. Data were analysed using thematic analysis.
Three themes were identified credible gerontological experts; challenging ageism and suboptimal services; and legitimising gerontological practice as a speciality.
Understanding the motivations to undertake a specialist gerontological programme and the impacts on practitioners and older people care and services will help inform the continuing professional development agenda for nurses and allied health professionals working in this field of practice. Policy makers, commissioners, managers, and educators can use the findings to inform continuing professional development priorities and provision for the gerontological workforce.
Understanding the motivations to undertake a specialist gerontological programme and the impacts on practitioners and older people care and services will help inform the continuing professional development agenda for nurses and allied health professionals working in this field of practice. Policy makers, commissioners, managers, and educators can use the findings to inform continuing professional development priorities and provision for the gerontological workforce.Coastal marine vegetation has been recently highlighted for its highly efficient carbon storage capacity. Among the sixty-four species of seagrass, Posidonia oceanica, a Mediterranean endemic species, appears to be the most effective in carbon fixation and storage. Based on new data from the study of one of the largest P. oceanica meadows in the Mediterranean Sea (100 km of coastline, 20 425 ha), and a synthesis of available data from the whole of the Mediterranean basin, the aim of this work is to evaluate the amount of carbon fixed each year by P. oceanica and sequestered in the matte, in relation with the mitigation of the impact of climate change (carbon sink). The mean total carbon fixation (blades, sheaths and rhizomes) per year varies between 33.5 and 426.6 g C.m-2 and the mean carbon sequestration (long-term sink in the matte), corresponding to the sheath and rhizome tissues, varies between 7.7 and 84.4 g C.m-2, with a clear decreasing trend according to depth because of the meadow density decrease. The synthesis of a hundred measurements made throughout the Mediterranean Sea and at depths between 0.5 and 32.0 m provides a basis for estimating the average annual carbon fixation and sequestration rate throughout the Mediterranean basin. The fixation of the blades is estimated at 1 024 t C.ha-1.yr-1, that of the sheaths at 220 t C ha-1.yr-1 and that of the rhizomes at 58 t C ha-1.yr-1; i.e. a total fixation rate of 1 302 t C ha-1.yr-1 and sequestration rate (dead sheaths and rhizomes) of 278 t C ha-1.yr-1. This annual carbon fixation represents only 0.61% on average of CO2 emissions/releases for all Mediterranean countries but in the large Mediterranean islands this fixation is on average 3.1% and can reach almost 14.4% for Corsica. Moreover, the major advantage of the P. oceanica meadow lies in its capacity to store carbon from annual carbon sequestration for centuries to millennia and can be compared to several terrestrial ecosystems considered to be efficient in carbon storage (peatlands).The current study investigated the effect of environmentally relevant mixtures of estrogens at levels representative of receiving waters on the metabolome of the Sydney rock oyster, Saccostrea glomerata. Oysters were exposed to a "low" and a "high" mixture of (xeno) estrogens (representative of Australian and global receiving waters respectively) for 7 days and digestive gland, gill, and gonad tissue were sampled for quantification of polar metabolites by 1H NMR spectroscopy. Exposure to both mixtures lowered body mass and altered the metabolite profile in the digestive glands. Comparatively, gills, and ovaries demonstrated lesser sensitivity to the mixtures, with significant metabolomic alterations observed only for the high mixture. The male gonad did not respond to either estrogenic exposure. In the responsive tissues, major metabolites including amino acids, carbohydrates, intermediates of the tricarboxylic acid cycle and ATP were all down-regulated and exhibited tissue-specific patterns of down-regulation with the greatest proportion of metabolites down-regulated due to estrogenic exposure in the digestive gland. Exposure to (xeno) estrogen mixtures representative of concentrations reported in receiving waters in Australia and globally can impact the metabolome and associated energy metabolism, especially in the digestive gland, translating to lower pools of available ATP energy for potential cellular homeostasis, somatic maintenance and growth, reproduction and fitness.An integrated process that includes catalytic co-pyrolysis of biomass/plastic wastes and in-line catalytic upgrading of pyrolysis gas were conducted to simultaneously produce aromatics-rich bio-oil and carbon nanotubes (CNTs). The influences of feedstocks blending ratio on the characteristics of bio-oil and CNTs were established. The reaction mechanism of carbon deposition during the system was also probed. The results showed that co-feeding plastic to biomass siginificantly enhanced the selectivity of monoaromatics (benzene, toluene, and xylene) from 5.6% for pure biomass to the maximum yield of 44.4% for 75.0% plastic ratio, and decreased naphthalene and its derivates from 85.9 to 41.7% correspondingly. The most synergistic effect on BTX selectivity occurred at 25% of plastic ratio. The multi-walled CNTs were successfully synethsized on Ni catalyst by utilizing prolysis gas as feedstocks. For pure biomass, the least CNTs yield with ultrafine diameters of 3.9-8.5 nm was generated via disproportionation reaction of CO which was derived from decarboxylation and decarbonylation of oxygenates on the ZSM-5 acid sites. With the rise of plastic ratio, sufficient hydrocarbons were produced for CNTs growth, endowing CNTs with long and straight tube walls, along with uniform diameters (~16 nm). The CNTs yield increased as high as 139 mg/g-cata. In addition, the decreased CO2 inhibited dry reforming with C1-C4 hydrocarbons and deposited carbon, avoiding excessive etching of CNTs. Thereby, high-purity CNTs with less defects were fabricated when plastic ratio was beyond 50% in the feedstock. The strategy is expected to improve the sustainability and economic viability of biomass pyrolysis.A valid, standardized tool for assessing workplace safety can help organizations and employers to detect potential safety risks. This is crucial to improve safety and protect employees and production against accidents and injuries. As no such tool has so far been developed for the waste management industry, this study aimed to establish the psychometric properties and the concurrent validity of the 11-item Brief Norwegian Safety Climate Inventory (Brief NORSCI). A cross-sectional questionnaire study was conducted with 543 workers from the formal Norwegian waste management industry. Exploratory and confirmatory factor analyses showed that the Brief NORSCI exhibited good psychometric properties. Replicating previous validation studies of the inventory, the findings suggested a three-factor structure reflecting Individual intention and motivation, Management's prioritization of safety, and Safety routines. The three first-order factors of the inventory could be combined in a composite second-order safety climate factor. Both the overall composite score and the three subscales correlated in the expected directions with measures of job characteristics (i.e., job demands and resources), leadership, social climate, and severe accidents, thus indicating high concurrent validity. This study supported the validity and reliability of the Brief NORSCI as an assessment tool to measure both individual safety perceptions and group level safety climate among waste management workers. The findings suggest that application of the Brief NORSCI as a safety assessment tool may contribute to the development of a stronger safety profile among organizations and companies in waste management.A field excavation of refusewitha short-termlandfillage from the Qingdao Xiaojianxi municipal solid waste (MSW) landfill was conducted. The physical composition and chemical properties of refuse with landfill ages of 1-4 years were studied, and the emission characteristics of odorous pollutants during the excavation period were monitored. The refuse aged 1-2 years has a higher proportion of combustible material than that the refuse aged 3-4 years, and the volatile content and calorific value in refuse aged 1-2 years were also higher than those in refuse aged 3-4 years, indicating that the refuse with a short-term landfill age was more suitable for incineration than refuse with a long-term landfill age. The pH and availablephosphorus (AP) gradually increased with increasing landfill age, while the total Kjeldahlnitrogen (TKN) and organic matter (OM) decreased. The contents of the heavy metals Cu, Zn, Ni, Pb and As generally decreased with landfill age, especially in refuse aged 2-4 years, whereas the Cr content showed no significant differences in refuse aged 1-4 years. The main odorous pollutants emitted during the excavation and screening periods were ammonia (NH3) and carbon disulfide (CS2), and the odor intensity of excavated refuse aged 1-3 years was higher than that of refuse aged 4 years. Under the condition of a small excavation area and continuous deodorization, the pollution intensity can meet the discharge standards of the factory boundary.
Effective teamwork and communication are correlated with improved patient care quality and outcomes. The belief that each team member contributes to excellent patient care in the operating room (OR) leads to a more productive work environment. However, poor teamwork and communication lead to poorer OR outcomes. We qualitatively and quantitatively explored perspectives of three OR professions (nursing, anesthesiology, and surgery) on teamwork and communication in the OR preinterprofessional and postinterprofessional in situ OR simulation.
One-on-one semi-structured interviews were conducted; 14 pre-in situ simulations during July-October 2017 (three surgery, four anesthesiology, and six nursing staff), and 10 post-in situ simulations during August-November 2017 (five surgery, four anesthesiology, and one nursing staff). Themes were identified inductively to create a codebook. The codebook was used to consensus code all interviews. This analysis informed the development of a quantitative survey distributed ll as a productive and supportive OR work environment.
The current obesity epidemic is associated with increased health care costs associated with comorbidities such as diabetes and heart disease as well as postoperative complications. However, the effect of obesity on operating room (OR) utilization, especially in common breast procedures, has not been completely evaluated. Our study is the first to examine the effect of patient obesity on operative time (OPT) for common breast procedures.
The American College of Surgeons National Surgical Quality Improvement Project databases for 2010-2018 were searched for this retrospective review. Patients undergoing common breast operations (lumpectomy, lumpectomy with sentinel lymph node biopsy (SLNB) (+/- injection), lumpectomy and axillary lymph node dissection (ALND), simple mastectomy, mastectomy with SLNB (+/- injection), and mastectomy with ALND) were filtered out by Current Procedural Terminology code and divided into three groups based on their body mass index (BMI) and weight. Using the two-sample t-test, OPT ling.
Patient BMI and weight significantly affect OPT for common breast procedures. Therefore, patient BMI should be taken into account to improve OR scheduling.
Robotic esophagectomies are increasingly common and are reported to have superior outcomes compared with an open approach; however, it is unclear if all institutions can achieve such outcomes. We hypothesize that early adopters of robotic technique would have improved short-term outcomes.
The National Cancer Database (2010-2016) was used to identify robotic esophagectomies. Early adopters were defined as programs which performed robotic esophagectomies in 2010-2011, late adopters in 2012-2013. Outcomes of esophagectomies performed between 2014 and 2016 were compared and included length of stay, number of lymph nodes evaluated, readmission, conversion rate, and 90-day mortality. Multivariable regressions, accounting for robotic esophagectomy volume, were used to control for confounding factors.
There were 37 early adopters and 35 late adopters. Between 2014 and 2016, 683 robotic esophagectomies were performed 446 (65.3%) by early adopters and 237 (34.7%) by late adopters. Early adopters were more likely to be academic programs (96.2 versus 72.8%, P<0.01). Other clinical and demographic variables were similar. Late adopters were found to have decreased a number of lymph nodes evaluated (coefficient -2.407, P=0.004) compared with early adopters. There were no significant differences in length of stay, readmissions, rate of positive margins, conversion from robotic to open, or 90-day mortality.
When accounting for robotic esophagectomy volume, late adoption of robotic esophagectomy was associated with a reduced lymph node harvest, but other postoperative outcomes were similar. These data suggest that programs can safely start new robotic esophagectomy programs, but must ensure an adequate case load.
When accounting for robotic esophagectomy volume, late adoption of robotic esophagectomy was associated with a reduced lymph node harvest, but other postoperative outcomes were similar. These data suggest that programs can safely start new robotic esophagectomy programs, but must ensure an adequate case load.
Although complication rates after thyroidectomy are well described in the literature, the timing of these events is less understood. This study delineates the timeline and risk factors for early adverse events after thyroidectomy.
This study included a retrospective review of 161,534 patients who underwent thyroidectomy between 2005 and 2018 using the American College of Surgeons National Surgical Quality Improvement Program database. Time to specific complications was analyzed for all patients undergoing thyroidectomy, with further stratification of hemithyroidectomy and total thyroidectomy cohorts. Univariate analyses were conducted to analyze demographics, preoperative comorbidities, and complications. A multivariate logistic regression model was generated to identify significant risk factors for 7-day postoperative complications.
The overall complication rate was 3.28%. A majority of complications arose before discharge including the following blood transfusion (96%), hematoma formation (68%), pneumstablish better preoperative communication and education to improve postoperative expectations for the provider and patient.
Although early complications after thyroidectomy are rare, they have a distinct time course, many of which occur after discharge. However, in selected patients undergoing outpatient thyroidectomy, overall risk of complications is decreased. Understanding timing helps establish better preoperative communication and education to improve postoperative expectations for the provider and patient.
Female surgeons are highly underrepresented in Asian countries, where prescriptive gender norms are widespread and more deeply embedded in societies.
A nationwide structured questionnaire was completed by 1741 Singaporean third- and fifth-year medical students after the completion of an 8-week general surgery rotation, during 2015-2017. Results were analyzed using mixed-effects hierarchical models which took into account clustering of survey responses under the teaching hospitals which students were posted to and medical students' year of study.
Female medical students had a poorer perception of general surgery than male students (3.22±0.91 versus 3.41±0.89; P<0.0001) before the clerkship. However, the clerkship improved female students' opinion to a greater extent than male students (+0.84±1.06 versus +0.59±1.03; P<0.0001), resulting in female and male students having comparable attitudes toward surgery after the clerkship (4.06±0.79 versus 4.00±0.87; P=0.2435). A total of 40.4% of female studenttudents to surgery.
A surgical clerkship itself could be regarded as an effective intervention for improving female medical students' enthusiasm for surgery, which may help to address the "pipeline problem" of few female students applying for surgical training after medical school. A greater emphasis on "pull factors" and pedagogical qualities of mentors could be used to improve the clerkship experience, to attract more female students to surgery.Hydrogels based on photocrosslinkable Hyaluronic Acid Methacrylate (HAMA) and Chondroitin Sulfate Methacrylate (CSMA) are presently under investigation for tissue engineering applications. HAMA and CSMA gels offer tunable characteristics such as tailorable mechanical properties, swelling characteristics, and enzymatic degradability. This review gives an overview of the scientific literature published regarding the pre-clinical development of covalently crosslinked hydrogels that (partially) are based on HAMA and/or CSMA. Throughout the review, recommendations for the next steps in clinical translation of hydrogels based on HAMA or CSMA are made and potential pitfalls are defined. Specifically, a myriad of different synthetic routes to obtain polymerizable hyaluronic acid and chondroitin sulfate derivatives are described. The effects of important parameters such as degree of (meth)acrylation and molecular weight of the synthesized polymers on the formed hydrogels are discussed and useful analytical techniques for their characterization are summarized. Furthermore, the characteristics of the formed hydrogels including their enzymatic degradability are discussed. Finally, a summary of several recent applications of these hydrogels in applied fields such as cartilage and cardiac regeneration and advanced tissue modelling is presented.Microbes have remarkable capabilities to attach to the surface of implanted medical devices and form biofilms that adversely impact device function and increase the risk of multidrug-resistant infections. The physicochemical properties of biomaterials have long been known to play an important role in biofilm formation. More recently, a series of discoveries in the natural world have stimulated great interest in the use of 3D surface topography to engineer antifouling materials that resist bacterial colonization. There is also increasing evidence that some medical device surface topographies, such as those designed for tissue integration, may unintentionally promote microbial attachment. Despite a number of reviews on surface topography and biofilm control, there is a missing link between how bacteria sense and respond to 3D surface topographies and the rational design of antifouling materials. Motivated by this gap, we present a review of how bacteria interact with surface topographies, and what can be learned from current laboratory studies of microbial adhesion and biofilm formation on specific topographic features and medical devices. We also address specific biocompatibility considerations and discuss how to improve the assessment of the anti-biofilm performance of topographic surfaces. We conclude that 3D surface topography, whether intended or unintended, is an important consideration in the rational design of safe medical devices. Future research on next-generation smart antifouling materials could benefit from a greater focus on translation to real-world applications.Chemo-resistance is an important barrier to effective treatment of ovarian cancer. Poly (ADP-ribose) polymerase (PARP) inhibitors are currently promising targeted drugs used to treat BRCA-mutant ovarian cancer. Ovarian cancer patients with BRCA 1/2 mutations appear to benefit better from PARP inhibitors and chemotherapy. Understanding the mechanisms underlying PARP inhibitors and chemotherapy resistance is urgently needed. There is increasing evidence that microRNAs (miRNAs) are involved in drug resistance. MiR-506-3p is an effective inhibitor of the epithelial-to-mesenchymal transition (EMT), and can enhance chemotherapy and olaparib response in high-grade serous ovarian cancer (HGS-OvCa). Enhancer of Zeste Homolog 2 (EZH2) is considered as a direct target of miR-506-3p. The silencing of EZH2 mimics the inhibitory effects of miR-506-3p on chemo-resistance and olaparib response. Rescue of EZH2 prevented the functions of miR-506-3p. Moreover, EZH2 activates the β-catenin pathway. MiR-506-3p overexpression decreased the level of β-catenin, and the sensitivity to olaparib and cisplatin mediated by miR-506-3p was partially reversed by regulating β-catenin expression in ovarian cancer. Our results suggest that miR-506-3p increases response to PARP inhibitors and cisplatin in serous ovarian cancer by targeting EZH2/β-catenin signal pathway, which opens the possibility of using miR-506-3p overexpression as a potential therapeutic for ovarian cancer.Progastrin is an unprocessed soluble peptide precursor with a well-described tumor-promoting role in colorectal cancer. It is expressed at small levels in the healthy intestinal mucosa, and its expression is enhanced at early stages of intestinal tumor development, with high levels of this peptide in hyperplastic intestinal polyps being associated with poor neoplasm-free survival in patients. Yet, the precise type of progastrin-producing cells in the healthy intestinal mucosa and in early adenomas remains unclear. Here, we used a combination of immunostaining, RNAscope labelling and retrospective analysis of single cell RNAseq results to demonstrate that progastrin is produced within intestinal crypts by a subset of Bmi1+/Prox1+/LGR5low endocrine cells, previously shown to act as replacement stem cells in case of mucosal injury. In contrast, our findings indicate that intestinal stem cells, specified by expression of the Wnt signaling target LGR5, become the main source of progastrin production in early mouse and human intestinal adenomas. Collectively our results suggest that the previously identified feed-forward mechanisms between progastrin and Wnt signaling is a hallmark of early neoplastic transformation in mouse and human colonic adenomas.A triple-layer model of the mica/water electrical double layer (EDL) unifies prediction of zeta potential, ion-exchange, and surface-force isotherms. The theory treats cations as partially dehydrated and complexed specifically to the anionic exchange sites of mica. A diffuse layer commencing at the outer Helmholtz plane (OHP) balances the surface charge not neutralized by adsorbed cations in the inner Helmholtz plane (IHP). Ion-binding equilibrium constants are assessed from zeta-potential measurements and used thereafter to predict ion-exchange isotherms and surface forces. Basal-plane mica surface charge is almost completely neutralized by specific binding of cations, including hydronium ions. The charge in the diffuse layer is only a few percent of the mica crystallographic charge density but leads to long-range electrostatic interactions between charged surfaces. The Grahame triple-layer model of the aqueous EDL provides a robust, quantitative, and unified description of the mica/water interface.This research aimed to isolate lactic acid bacteria (LAB) from apple surface and to reveal their potential to inhibit the growth of Penicillium expansum. Besides, their ability to detoxify fruit juices contaminated with mycotoxin patulin, produced by this fungi, was also studied. The isolation was performed on a typical MRS medium under ambient conditions. The molecular identification of the strains was done by sequencing the 16S rRNA genes. Antifungal activities of the isolated strains have been evaluated using dual agar plate assay protocol. A total of 11 LAB isolates was obtained from apples. These isolates showed phenotypic traits consistent with the genera of LAB. They have been identified as Leuconostoc mesenteroides subsp. mesenteroides and Weissella paramesenteroides. Among them, the strain LB7 showed exciting inhibitory activities in vitro against P. expansum. LB7 also successfully detoxified homemade and commercial fruit juices contaminated with patulin. Further research will bring the application prospects of these LABs in food biocontrol and biopreservation strategies.Extra ingredients are often used in traditional sourdough production recipes by artisan bakeries. These ingredients may be the source of microorganisms or stimulate the growth and/or the metabolic activities of the microorganisms added to or naturally present in the flour-water mixture. The present study examined the influence of the addition of lemon juice or apple juice as source of citrate or malate, respectively, on the growth and activity of the citrate- and malate-positive Companilactobacillus crustorum LMG 23699 strain (formerly known as Lactobacillus crustorum LMG 23699), used to initiate firm (dough yield of 200) wheat sourdough productions, and on the flavour of the baked goods produced. Three fermentation strategies were applied, namely one-step long fermentation sourdough production processes with the addition of juice at the start (Type 2) and backslopped fermentations with the addition of juice either only at the start of the sourdough productions or at the start of the sourdough productions andcreased the initial concentrations of the carbohydrates (fructose, glucose, and sucrose) and sugar alcohols (mannitol and sorbitol), which were exhausted upon backslopping or accumulated in the sourdough matrix, respectively. Baked goods produced using sourdoughs obtained from the Type 2 and Type 3 sourdough productions with the addition of juice at each backslopping step were significantly different in flavour from doughs supplemented with the respective juices and lactic acid and/or Type 3 sourdough productions with the addition of juice only at the start.
With the epidemic of coronavirus disease 2019 (COVID-19), the healthcare workers (HCWs) require proper respiratory personal protective equipment (rPPE) against viral respiratory infectious diseases (VRIDs). It is necessary to evaluate which type of mask and manner of wearing is the best suitable rPPE for preventing the VRID.
A Bayesian network meta-analysis was performed to comprehensively analyze the protective efficacy of various rPPE.
This network meta-analysis protocol was registered in an international prospective register of systematic reviews (CRD42020179489). Electronic databases were searched for cluster randomized control trials (RCTs) of comparing the effectiveness of rPPE and wearing manner in preventing HCWs from VRID. The primary outcome was the incidence of laboratory-confirmed viral respiratory infection reported as an odds ratio (OR) with the associated 95% credibility interval (CrI). The secondary outcome was the incidence of clinical respiratory illness (CRI) reported as an OR with th VRID.
This study was to examine the relationship between health literacy (HL) and health behaviors in the South Bohemia Region in the Czech Republic (CR) and compare them to HL and health behaviors in the Visegrád group countries (Czech Republic, Hungary, Poland, and Slovakia). The paper reports the results from the research in the CR.
A quantitative descriptive study.
The sample was stratified by sex and age and included a representative sample of 303 adults. The data were collected using the combination of a country-specific questionnaire with the HLS-EU-16 standardized questionnaire.
Exercise was significantly associated with perceived health and HL; those with a lower level of HL did not exercise during the previous month. Based only on full answers (N=251), inadequate HL was identified in 17.5% of the respondents (44), marginal HL in 31.5% (77), and adequate HL in 51% (128) of the respondents. Nearly 49% of the participants evaluated their health as 'good', 25.7% rated their health as 'very good' and 'satisfactory' by 25.7%. But 41.6% experienced one or more chronic diseases, 37.6% had some limitations to their health, and 20.5% smoked. For alcohol consumption, 26% drank weekly and 23% drank two to three times a month. Exercise varied from never (29.7%) to daily (7.9%).
Based on our results, we conclude that health behavior risk factors are still present in the South Bohemia region of the CR regardless of levels of HL reported on the HLS-EU-16.
Based on our results, we conclude that health behavior risk factors are still present in the South Bohemia region of the CR regardless of levels of HL reported on the HLS-EU-16.