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Publication
Journal: International Immunopharmacology
December/3/2021
Abstract
The global strategy to control coronavirus disease is based on the availability of COVID-19 vaccines. More information about response to a single dose vaccine could help to better understand and optimize the management of the vaccine campaign. Workers from the University of Rome "Tor Vergata" and the University Hospital of University of Rome "Tor Vergata," were monitored during their vaccination program. Serum samples were collected between the first and second dose and after the second dose. University personnel has been vaccinated with two doses of Vaxzevria vaccine 12 weeks apart, while hospital personnel has been vaccinated with two doses of Cominarty 3 weeks apart. IgG antibodies (Abs) against the Receptor Binding Domain (RBD) of the virus spike surface glycoprotein and neutralizing antibodies (NT) anti-SARS-CoV-2 that block the interaction between RBD and the surface receptor cellular angiotensin converting enzyme (ACE2) were measured using the CL-series Mindray chemiluminescent assays, respectively. Different amounts of antibodies produced after the two doses of vaccine were found. Individuals with a previous natural infection developed a higher Abs titer. Among the individuals with no history of past SARS-CoV-2 infection, 5% had an Abs level of the same order of magnitude of infected people, suggesting that they acquired the infection in an asymptomatic way. In such individuals, one dose of vaccine may be sufficient to obtain a protective immune response.
Publication
Journal: Journal of Pediatric Hematology/Oncology
December/3/2021
Abstract
Rationale: Juvenile myelomonocytic leukemia (JMML) is a rare hematopoietic disorder, which is more rarely accompanied by monosomy 5 or deletion of the long arm of chromosome 5q (-5/5q-) or monosomy 5 (5q-/-5), and hemophagocytic lymphohistiocytosis (HLH) is a rare, uncontrolled hyperinflammation condition, which is more rarely secondary to JMML. Up to now, only a few cases of JMML with -5/5q- and HLH secondary to JMML were described. Here we described an extremely rare case of HLH second to JMML with 5q-.
Patient concerns: The patient had multiple cafe-au-lait-spots at birth and was found that NF1 gene mutation was positive. At his 6 years old, he developed hepatosplenomegaly, anemia, thrombocytopenia, monocyte count 4.12×109/L in peripheral blood, 13% blasts in peripheral blood, and 11% blasts in bone marrow, without BCR/ABL rearrangement, combining with positive NF1 gene mutation, he was diagnosed as JMML. In the bone marrow, there was chromosomal abnormalities with -5/5q-. In the treatment, HLH occurred.
Diagnoses: The patient was diagnosed as secondary HLH to JMML.
Interventions: The patient received the chemotherapy treatment of the improved diffuse alveolar hemorrhage protocol, and meanwhile, he prepared for hematopoietic stem cell transplantation. Then on the basis of anti-infection, symptomatic and supportive therapy, he was commenced the treatment according to the HLH-2004 protocol.
Outcomes: He had a partial response, manifesting that his fever resolved, but the blood coagulation function did not improve, and the severe thrombocytopenia remained. Then, the parents refused the continual treatment, and the child died of intracranial hemorrhage 3 months after the diagnosis of JMML.
Lessons: JMML and HLH were relatively easy to diagnose based on clinical and laboratory results. Due to the low incidence of JMML with -5/5q- and HLH secondary to JMML, no clinical practice guidelines for the treatment of the disease have been established yet. The clinical data of a case of HLH secondary to JMML with 5q- were analyzed, and relevant studies were studied.
Publication
Journal: BMJ Open
December/3/2021
Abstract
Objective: Nursing regulators are important governance structures for nurses who are critical to the achievement of universal health coverage (UHC). This study examined the perspectives of the heads of nursing education institutions (NEIs) in Ghana and South Africa on the functioning and effectiveness of the respective nursing regulators.
Design: This was a cross-sectional survey.
Setting: This study was conducted in Ghana and South Africa PARTICIPANTS: Heads of accredited NEIs in Ghana (n=65) and in South Africa (n=39).
Results: In South Africa, the mean score for overall functioning of the South African Nursing Council (SANC) was 4.6 (SD 1.97), whereas the mean score for overall functioning of the Nursing and Midwifery Council of Ghana (N&MC) was 7.1 (SD 1.7) (p<0.0001). Similarly, the mean score for effectiveness of the SANC by NEIs was 5.1, compared with the mean effectiveness score of 7.2 for the N&MC (p<0.001).Compared to the SANC, the heads of NEIs scored the N&MC higher on each of the six functional areas of policy-making (Ghana=7.06; SA=4.56); accreditation (Ghana=7.40; SA=4.10) legal and disciplinary actions (Ghana=6.45; SA=5.52); examination (Ghana=7.84; SA=5.00); registration (Ghana=8.27; SA=5.96) and communication and transparency (Ghana=6.87; SA=6.05).
Conclusion: Both the N&MC and SANC are well-established regulators and are vital to ensure that the nursing workforce in each country is able to deliver quality healthcare, thereby contributing to UHC and population health improvements. However, the study findings suggest the need for concerted efforts to improve the functioning and effectiveness of the regulators, especially the SANC. The six functional areas could guide the necessary improvements in regulator functioning and effectiveness, in partnership with relevant stakeholders.
Keywords: education & training (see medical education & training); health policy; organisational development; public health.
Publication
Journal: Aging
December/3/2021
Abstract
Circadian dysregulation involves malignant tumor initiation and progression, but the understanding of circadian rhythm's roles in bladder cancer (BCa) remains insufficient. The circadian rhythm-related genes were collected and clustered based on the Cancer Genome Atlas (TCGA), and the clustering was significantly associated with the prognosis and risk clinicopathological features. Through genomic difference analysis and gene pairing, a circadian rhythm-related signature was successfully established. Kaplan-Meier survival analysis and time-dependent receiver operating curves displayed that the prognosis model was a reliable prognosis biomarker both in the training cohort (n = 396, P = 2.687e-10) and external validation cohort (n = 224, P = 1.45e-02). The patients with high risk have high immune infiltration and high expression of immune checkpoint genes, which partly account for the poor prognosis. TIDE algorithm and the validation in IMvigor210 cohort indicated that the risk signature was a promising marker for the immunotherapeutic response. The risk model could also predict the therapeutic response of cisplatin, which was validated in the Genomics of Drug Sensitivity in Cancer database (P = 0.0049), TCGA (P = 0.038), and T24 BCa cells treated with cisplatin. The functional enrichment showed the risk model was significantly correlated with some malignant phenotypes, such as angiogenesis, epithelial-mesenchymal transition, and KRAS signaling pathway. Totally, we proposed a novel circadian rhythm-related signature for prognosis evaluation, which also helped to predict the immune infiltration and cisplatin sensitivity in BCa.
Keywords: bladder cancer; circadian rhythm; cisplatin; immunity; prognosis.
Publication
Journal: Clinical Medicine
December/3/2021
Abstract
Introduction: There is growing recognition of the need for perioperative medicine services for older surgical patients. Comprehensive geriatric assessment and optimisation methodology has been successfully used to improve perioperative outcomes at tertiary centres. This paper describes translation of an established model of geriatrician-led perioperative care to a district general hospital (DGH) setting.
Methods: A mixed methods quality improvement programme was used and included stakeholder co-design, identification of core components, definition of mechanisms for change, and measurement of impact through qualitative and quantitative approaches.
Results: Within 18 months, a substantive perioperative service for older people was established at a DGH, funded by the surgical directorate. Key outcomes included reduction in length of stay and 30-day readmission and positive staff and patient experience.
Discussion: This study is in keeping with improvement science literature demonstrating the importance of a mixed-methods approach in translating an evidenced-based intervention into another setting, maintaining fidelity and replicating results.
Keywords: POPS; comprehensive geriatric assessment; frailty; implementation science; perioperative medicine for older people undergoing surgery; quality improvement; surgery.
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Publication
Journal: ISA Transactions
December/3/2021
Abstract
Product rate and grade transitions are two significant operations undertaken by process plants to operate in uncertain environments. Rate transitions, typically dictated by economic considerations, are often implemented in open loop via a throughput manipulator (TPM). The absence of feedback of product rate to manipulate the TPM results in an offset during rate/grade transitions as well as in presence of feed-side disturbances. In this work, we explore use of a simple PI controller based supervisory control layer that guides the plantwide regulatory layer to achieve product rate targets during grade transition or in the presence of feed grade disturbances. While such a layer cannot incorporate optimal operation and constraint handling explicitly as in model predictive control, it obviates the need for advanced process control elements that medium-to-small scale industries can ill-afford. The PI based supervisory-regulatory control structure is illustrated using simulated case studies on a prototypical process for diacetone alcohol production comprising of a reactor followed by two distillation columns and a recycle.
Keywords: Diacetone alcohol production; Grade transition; Plantwide control; Supervisory control; Throughput manipulator.
Publication
Journal: Science
December/3/2021
Abstract
Previous studies indicate that children are exposed to different literacy experiences at home. Although these disparities have been shown to affect children's literacy skills, it remains unclear whether and how home literacy practices influence brain activity underlying word-level reading. In the present study, we asked parents of French children from various socioeconomic backgrounds (n = 66; 8.46 ± 0.36 years, range 7.52-9.22; 20 girls) to report the frequency of home literacy practices. Neural adaptation to the repetition of printed words was then measured using functional magnetic resonance imaging (fMRI) in a subset of these children (n = 44; 8.49 ± 0.33 years, range 8.02-9.14; 13 girls), thereby assessing how sensitive was the brain to the repeated presentation of these words. We found that more frequent home literacy practices were associated with enhanced word adaptation in the left posterior inferior frontal sulcus (r = 0.32). We also found that the frequency of home literacy practices was associated with children's vocabulary skill (r = 0.25), which itself influenced the relation between home literacy practices and neural adaptation to words. Finally, none of these effects were observed in a digit adaptation task, highlighting their specificity to word recognition. These findings are consistent with a model positing that home literacy experiences may improve children's vocabulary skill, which in turn may influence the neural mechanisms supporting word-level reading.
Publication
Journal: Journal for ImmunoTherapy of Cancer
December/3/2021
Abstract
Background: Induction of CD8+ T cells that recognize immunogenic, mutated protein fragments in the context of major histocompatibility class I (MHC-I) is a pressing challenge for cancer vaccine development.
Methods: Using the commonly used murine renal adenocarcinoma RENCA cancer model, MHC-I restricted neoepitopes are predicted following next-generation sequencing. Candidate neoepitopes are screened in mice using a potent cancer vaccine adjuvant system that converts short peptides into immunogenic nanoparticles. An identified functional neoepitope vaccine is then tested in various therapeutic experimental tumor settings.
Results: Conversion of 20 short MHC-I restricted neoepitope candidates into immunogenic nanoparticles results in antitumor responses with multivalent vaccination. Only a single neoepitope candidate, Nesprin-2 L4492R (Nes2LR), induced functional responses but still did so when included within 20-plex or 60-plex particles. Immunization with the short Nes2LR neoepitope with the immunogenic particle-inducing vaccine adjuvant prevented tumor growth at doses multiple orders of magnitude less than with other vaccine adjuvants, which were ineffective. Nes2LR vaccination inhibited or eradicated disease in subcutaneous, experimental lung metastasis and orthotopic tumor models, synergizing with immune checkpoint blockade.
Conclusion: These findings establish the feasibility of using short, MHC-I-restricted neoepitopes for straightforward immunization with multivalent or validated neoepitopes to induce cytotoxic CD8+ T cells. Furthermore, the Nes2LR neoepitope could be useful for preclinical studies involving renal cell carcinoma immunotherapy.
Keywords: adaptive immunity; antigens; vaccination.
Publication
Journal: npj Vaccines
December/3/2021
Abstract
Numerous vaccine candidates against SARS-CoV-2, the causative agent of the COVID-19 pandemic, are under development. The majority of vaccine candidates to date are designed to induce immune responses against the viral spike (S) protein, although different forms of S antigen have been incorporated. To evaluate the yield and immunogenicity of different forms of S, we constructed modified vaccinia virus Ankara (MVA) vectors expressing full-length S (MVA-S), the RBD, and soluble S ectodomain and tested their immunogenicity in dose-ranging studies in mice. All three MVA vectors induced spike-specific immunoglobulin G after one subcutaneous immunization and serum titers were boosted following a second immunization. The MVA-S and MVA-ssM elicited the strongest neutralizing antibody responses. In assessing protective efficacy, MVA-S-immunized adult Syrian hamsters were challenged with SARS-CoV-2 (USA/WA1/2020). MVA-S-vaccinated hamsters exhibited less severe manifestations of atypical pneumocyte hyperplasia, hemorrhage, vasculitis, and especially consolidation, compared to control animals. They also displayed significant reductions in gross pathology scores and weight loss, and a moderate reduction in virus shedding was observed post challenge in nasal washes. There was evidence of reduced viral replication by in situ hybridization, although the reduction in viral RNA levels in lungs and nasal turbinates did not reach significance. Taken together, the data indicate that immunization with two doses of an MVA vector expressing SARS-CoV-2 S provides protection against a stringent SARS-CoV-2 challenge of adult Syrian hamsters, reaffirm the utility of this animal model for evaluating candidate SARS-CoV-2 vaccines, and demonstrate the value of an MVA platform in facilitating vaccine development against SARS-CoV-2.
Publication
Journal: Clinical Cancer Research
December/3/2021
Abstract
Purpose: Kaposi sarcoma (KS) is caused by Kaposi sarcoma herpesvirus ((KSHV), also known as human herpesvirus 8 (HHV-8)). KS, which develops most frequently among people with HIV, is generally treated with chemotherapy, but these drugs have acute and cumulative toxicities. We previously described initial results of a trial of pomalidomide, an oral immunomodulatory derivative of thalidomide, in patients with KS. Here, we present results on the full cohort and survival outcomes.
Experimental design: Participants with KS with or without HIV were treated with pomalidomide 5mg once daily for 21 days per 28-day cycle with aspirin 81mg daily for thromboprophylaxis. Participants with HIV received antiretroviral therapy. Response was defined by modified version of the AIDS Clinical Trial Group KS criteria. We evaluated tumor responses (including participants who had a second course), adverse events, progression-free survival (PFS), and long-term outcomes.
Results: Twenty-eight participants were enrolled. Eighteen (64%) were HIV-positive, 21 (75%) had advanced (T1) disease. Overall response rate was 71%: 95% confidence interval (CI) 51-87%. Twelve of 18 HIV-positive (67%; 95% CI: 41-87%) and 8 of 10 HIV-negative participants (80%; 95% CI: 44-97%) had a response. Two of 4 participants who received a second course of pomalidomide had a partial response. The median PFS was 10.2 months (95% CI: 7.6-15.7 months). Grade 3 neutropenia was noted among 50% of participants. In the follow-up period, 3 participants with HIV had other KSHV-associated diseases.
Conclusions: Pomalidomide is a safe and active chemotherapy-sparing agent for the treatment of KS among individuals with or without HIV.
Publication
Journal: BioImpacts
December/3/2021
Abstract
Comprehensive research on rural-urban disparities in the association of hyperuricaemia (HUA) with cardiovascular disease (CVD) in China, especially among minority groups, is limited. We explored the HUA-CVD relationship between rural and urban areas within ethnic Chinese groups. We included Dong, Miao, and Bouyei adults in Southwest China from the China Multi-Ethnic Cohort Study. Multivariable logistic regression models were used to assess the relationship between HUA and CVD in both residences. We performed stratified analyses by sex and age. The study population included 16,618 people (37.48% Dong, 30.00% Miao, and 32.52% Bouyei) without a reduced estimated glomerular filtration rate. We identified 476 (188 Dong, 119 Miao, and 169 Bouyei) and 175 (62 Dong, 77 Miao, and 36 Bouyei) CVD cases in rural and urban areas. Compared to urban residents, an at least 49% increased CVD risk (adjusted OR 1.49, 95%CI 1.06-2.08 for the Dong ethnic group; 1.55, 1.07-2.25 for the Bouyei ethnic group) and a 1.65-fold elevated coronary heart disease risk (1.65, 1.03-2.64) related to HUA was present in rural residents. Moreover, HUA was positively associated with increased risk of CVD and coronary heart disease in rural women (2.05, 1.26-3.31; 2.11, 1.19-3.75) and rural older adults (1.83, 1.22-2.75; 2.32, 1.39-3.87) among the Bouyei ethnic group, respectively. We found rural elderly individuals with HUA among the Dong ethnic group had a 52% elevated risk of CVD (1.52, 1.05-2.21); furthermore, an at least 79% increased risk of stroke related to HUA was observed in women (2.24, 1.09-4.62) and elderly people (1.79, 1.02-3.13) in rural areas among the Dong ethnic group. But a positive association was not found among the Miao ethnic group. Screening early-onset HUA patients may be helpful for the control and prevention of CVD in rural residents, especially for women and older adults living in a rural community, among the Dong and Bouyei ethnic groups in China.
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Publication
Journal: Mayo Clinic Proceedings
December/3/2021
Abstract
Objective: To investigate the utility of Charlson comorbidity index (CCI) as a measure of comorbidity burden to predict procedural outcomes after de novo cardiac implantable electronic device (CIED) implantation.
Methods: All de novo CIED implantations in the United States National Inpatient Sample between 2015 and 2018 were retrospectively analyzed, stratified by CCI score (0=no comorbidity burden, 1=mild, 2=moderate, ≥3=severe). Multivariable logistic regression models were performed to examine the association between unit CCI score (scale) and in-hospital outcomes (major adverse cerebrovascular and cardiovascular events [MACCE]: composite of all-cause mortality, acute ischemic stroke, thoracic and cardiac complications, and device-related complications; and MACCE individual components).
Results: Of 474,475 CIED procedures, the distribution of CCI score was as follows: CCI=0 (17.7%), CCI=1 (21.8%), CCI=2 (18.7%), and CCI=3+ (41.8%). Charlson comorbidity index score was associated with increased odds ratios of MACCE (1.10; 95% CI, 1.09 to 1.11), all-cause mortality (1.23; 95% CI, 1.21 to 1.25), and acute stroke (1.45; 95% CI, 1.44 to 1.46). This finding was consistent across all CIED groups except the cardiac resynchronization therapy groups in which CCI was not associated with increased risk of mortality. A higher CCI score was not associated with increased odds of procedural (thoracic and cardiac) and device-related complications.
Conclusion: In a nationwide cohort of CIED procedures, higher comorbidity burden as measured by CCI score was associated with an increased risk of in-hospital mortality and acute ischemic stroke, but not procedure-related (thoracic and cardiac) or device-related complications. Objective assessment of comorbidity burden is important to risk-stratify patients undergoing CIED implantation for better prognostication of their in-hospital survival.
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Publication
Journal: Rev Psiquiatr Salud Ment (Engl Ed)
December/3/2021
Abstract
Introduction: A high prevalence of obsessive-compulsive symptoms (OCSs) in anxiety-depressive disorders ranging from 30 to 67% has been described.
Objective: This study aims to assess the presence and persistence of OCSs in an outpatient sample of subjects with anxiety and depressive disorders, as well as its relationship with recent life events (RLEs) and/or traumatic experiences (TEs).
Method: We conducted a prospective, observational, analytical study of 200 subjects with DSM-5 diagnoses of anxiety and/or depression. Participants were included by consecutive sampling and were evaluated at baseline and after 6-12 months (mean 8.5 months) of follow-up. The severity of the symptoms was assessed through the Hamilton Anxiety Scale (HARS) and Hamilton Scale for the evaluation of depression (HRSD-17), and comorbidity was assessed through the International Neuropsychiatric Interview (MINI). The Revised Inventory of Obsessions and Compulsions (OCI-R), the Recent Vital Changes Questionnaire (CVSV), and the Diagnostic Scale for Post-Traumatic Stress (PDS) were also administered.
Results: 54% of the sample presented OCSs, and 30.5% presented one or more TEs throughout life. At the baseline visit, the presence of OCSs was associated with the severity of depressive symptoms (p=0.028), the presence of TEs (p<0.01), symptoms of post-traumatic stress disorder (p<0.01) and the number of RLEs (p<0.01). Response rate at follow-up was 38%, and persistence of OCSs was found in 60.5% of patients, independent of depressive or anxious symptoms, but was associated with the number of RLEs (p<0.01).
Conclusion: The presence of OCSs in patients with anxiety and depressive disorders is frequent and persistent. Anxious-depressive patients with a history of TEs and RLEs had higher OCS levels. These findings highlight the importance of early detection and the use of therapeutic strategies focused on resilience to stress and trauma.
Keywords: Anxiety and depressive disorders; Estrés; Eventos traumáticos; OCD; Obsessive–compulsive symptoms; Stress; Síntomas obsesivo-compulsivos; TOC; Trastornos de ansiedad y depresión; Traumatic events.
Publication
Journal: Light: Science and Applications
December/3/2021
Abstract
Laser speckle contrast imaging (LSCI) is a powerful tool to monitor blood flow distribution and has been widely used in studies of microcirculation, both for animal and clinical applications. Conventionally, LSCI usually works on reflective-detected mode. However, it could provide promising temporal and spatial resolution for in vivo applications only with the assistance of various tissue windows, otherwise, the overlarge superficial static speckle would extremely limit its contrast and resolution. Here, we systematically investigated the capability of transmissive-detected LSCI (TR-LSCI) for blood flow monitoring in thick tissue. Using Monte Carlo simulation, we theoretically compared the performance of transmissive and reflective detection. It was found that the reflective-detected mode was better when the target layer was at the very surface, but the imaging quality would rapidly decrease with imaging depth, while the transmissive-detected mode could obtain a much stronger signal-to-background ratio (SBR) for thick tissue. We further proved by tissue phantom, animal, and human experiments that in a certain thickness of tissue, TR-LSCI showed remarkably better performance for thick-tissue imaging, and the imaging quality would be further improved if the use of longer wavelengths of near-infrared light. Therefore, both theoretical and experimental results demonstrate that TR-LSCI is capable of obtaining thick-tissue blood flow information and holds great potential in the field of microcirculation research.
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Publication
Journal: Clinical Medicine
December/3/2021
Abstract
Background: The decision to admit patients to hospital in low-resource settings have been poorly investigated.
Aim: We aimed to determine the association of a disposition score determined on arrival with the decision subsequently made to admit or discharge the patient. The score awarded one point for altered mental status, one point for impaired mobility and one point for low oxygen saturation.
Methods: The mental status, mobility and oxygen saturation on arrival of 5,334 consecutive patients attending a combined emergency and outpatient department in a low-resource Ugandan hospital were recorded. Admission decisions were subsequently made independently by clinicians unaware to the score.
Results: Most patients (n=3,876; 73%) had a disposition score of zero and only 25 of these patients (0.6%) were subsequently admitted. A total of 646 (12.1%) patients were admitted. Only 301 (5.6%) patients had a score of 3 points and 263 (87.4%) of these were admitted. The C statistic for the discrimination of the score for admission was 0.953 (95% confidence interval 0.941-0.964).
Conclusion: In a low-resource setting, a simple score based on mental status, mobility and oxygen saturation identified outpatient and emergency department patients most and least likely to be subsequently admitted to hospital with a high degree of discrimination.
Keywords: admission decisions; admission prediction; admission process; emergency admissions; triage scores.
Publication
Journal: JMV-Journal de Medecine Vasculaire
December/3/2021
Abstract
Introduction: Treatment of cancer-associated thrombosis (CAT) requires specific approaches, although it is well codified in most cases. Current national and international (International Initiative on Cancer and Thrombosis, ITAC) Clinical Practice Guidelines (CPG) recommend the use of low-molecular-weight heparin (LMWH) over 6 months as first treatment option, and anticoagulation should be maintained thereafter as long as cancer is active. Since compliance improves when patients understand their disease and related treatments, we created a dedicated patient education program (PEP) for CAT, aiming to improve quality of care.
Methods: Retrospective analysis of all patients who voluntarily joined the PEP for CAT from 2014 to 2020.
Results: In total, 182 cancer patients (median age, 64.9 years) were included, 53.3% with metastatic disease. A total of 528 PEP sessions (median, 3 per patient) were delivered. After PEP completion, the rate of self-injections or those performed at home by a relative had increased from 49.1% to 59.8% (P=0.05). Quality of life had improved significantly (P=0.025) and 90.0% of patients reported adhering to anticoagulant therapy.
Conclusion: Implementation of a structured and personalized PEP for CAT is feasible, allowing to improve cancer patient empowerment, adherence to CAT treatment and quality of life. The Groupe francophone et cancer (GFTC) members aim at facilitating access to CAT-PEP for both patients and caregivers and use of the multi-language ITAC-CPG mobile app (free access: www.itaccme.com) to improve the care and quality of life of patients with CAT.
Keywords: Anticoagulant; Cancer-associated thrombosis; Clinical practice guidelines; Multidisciplinary care program; Patient education program; Quality of care; Quality of life.
Publication
Journal: BMC Pregnancy and Childbirth
December/3/2021
Abstract
Background: Thrombotic thrombocytopenic purpura (TTP) is a severe and life-threatening disease. Given its heterogeneous clinical presentation, the phenotype of TTP during pregnancy and its management have not been well documented.
Case presentation: We report here a 25-year-old woman, G1P0 at 36 weeks gestation, who developed severe thrombocytopenia and anemia. She was performed an emergent caesarean section 1 day after admission because of multiple organ failure. As ADAMTS 13 enzyme activity of the patient was 0% and antibodies were identified by enzyme-linked immunosorbent assay, she was diagnosed as acquired thrombotic thrombocytopenic purpura (aTTP). Furthermore, asymptomatic primary Sjögren's syndrome was incidentally diagnosed on screening. After treatment with rituximab in addition to PEX and steroids, the activity of the ADAMTS 13 enzyme increased significantly from 0 to 100%.
Conclusions: To the best of our knowledge, this is the first case report of concomitant TTP and asymptomatic Sjögren's syndrome in a pregnant woman. It highlights the association between pregnancy, autoimmune disease, and TTP. It also emphasizes the importance of an enzyme-linked immunosorbent assay in the diagnosis and rituximab in the treatment of patients with acquired TTP.
Keywords: Pregnancy; Rituximab; Sjögren’s syndrome; Thrombotic thrombocytopenic purpura.
Publication
Journal: BMC Pulmonary Medicine
December/3/2021
Abstract
Background: Sarcoidosis is granulomatous disease of unknown origin affecting organ function and quality of life. The King's Sarcoidosis Questionnaire (KSQ) serves as a tool to assess quality of life in sarcoidosis patients with general health and organ specific domains. A German translation has been validated in a German cohort. In this study we assessed, whether clinical parameters influence KSQ scores.
Methods: Clinical data (e.g. lung function, organ impairment, serological parameters) for the German validation cohort were extracted from clinical charts and investigated by correlation and linear regression analyses.
Results: KSQ subdomain scores were generally lower in patients with respective organ manifestation or on current therapy. LUNG subdomain was significantly predicted by lung functional parameters, however for general health status, only FeV1 exerted significant influence. GHS was not influenced by serological parameters, but was significantly negatively correlated with body mass index (BMI). KSQ provides additional information beyond lung function, clinical or serological parameters in sarcoidosis patients. Notably, high BMI is significantly negatively associated with patients' well-being as measured by KSQ-GHS.
Conclusion: This observation may direct further studies investigating the effect of obesity on sarcoidosis-related quality of life and strategies to intervene with steroid-sparing therapies and measures of life style modifications. Trial registration This study was registered in the German Clinical Trials Register (reference number DRKS00010072). Registered January 2016.
Keywords: King’s Sarcoidosis Questionnaire; Quality of life; Sarcoidosis.
Publication
Journal: BMC Infectious Diseases
December/3/2021
Abstract
Background: Approximately one-fourth of the global population is latently infected with Mycobacterium tuberculosis. An understanding of the burden of latent tuberculosis infection (LTBI) among immigrants compared with the general Korean population should be the first step in identifying priority groups for LTBI diagnosis and treatment. The study aimed to compute the age-standardized LTBI prevalence and predictors among immigrants with LTBI in South Korea.
Methods: In 2018, the Korea Disease Control and Prevention Agency implemented a pilot LTBI screening project for immigrants using a chest radiography and the QuantiFERON Gold In-Tube assay. A standardized prevalence ratio (SPR) was computed to compare the LTBI burden in immigrants and the general Korean population.
Results: During the duration of the project, a total of 8108 immigrants (5134 males and 2974 females) underwent LTBI screening. The SPR of 1.547 (95% confidence interval [CI] 1.468-1.629) in males and 1.261 (95% CI 1.177-1.349) in females were both higher than the Korean reference population. Furthermore, among the immigrants, those aged < 40 years and Korean diaspora visa holders had a higher SPR.
Conclusion: This study found a higher LTBI prevalence among immigrant population in South Korea compared to that in the general Korean population, and the SPR was higher among those aged < 40 years and the Korean diaspora. The findings can be used as baseline evidence for including immigrants in South Korea in the at-risk group with a priority need for LTBI screening and treatment.
Keywords: Immigrant screening; Standardized prevalence ratio; Tuberculosis screening.
Publication
Journal: JMV-Journal de Medecine Vasculaire
December/3/2021
Abstract
Chemodectomas (CBTs) are the most frequently encountered tumours at the carotid bifurcation. Even if rare and commonly benign, their development close to the head and neck structures is often source of morbidity by compression and infiltration. Therefore, in order to avoid permanent neurologic or vascular complications these infrequent lesions need to be early removed. The total excision may be technically challenging and requires extensive expertise in surgical neck anatomy and a cooperative multidisciplinary approach. Almost a quarter of CBTs infiltrate carotid vessels so vascular expertise is pivotal in their resection. The present study aims to give an overview of vascular specificity and procedures required during surgical excision of such tumors to assist and guide treating physicians who encounter CBTs. This overview will particularly emphasize current therapeutic options: we discuss the referral criteria that should guide the decision about what type of preoperative care and surgical procedure should be offered to the affected patients. We also specify the epidemiologic data, screening recommendations and outcomes achieved with the different therapeutic approaches. The clinical, operative and follow-up data about a case of a Shamblin III carotid body tumour surgically removed by a multidisciplinary team at our Institution are also reported.
Keywords: Carotid body tumour; Chemodectomas (CBTs); Neoplasms of the neck; Paraganglioma.
Publication
Journal: Spine Journal
December/3/2021
Publication
Journal: JMV-Journal de Medecine Vasculaire
December/3/2021
Abstract
Keywords: Endovascular treatment; Iliac artery; Medical treatment; Spontaneous dissection; Surgery.
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Publication
Journal: JMV-Journal de Medecine Vasculaire
December/3/2021
Abstract
Keywords: Chronic venous insufficiency; Liberal Nurse; Lower Limb Venous Compression Devices (LVCD).
Publication
Journal: Journal of Oral and Maxillofacial Surgery
December/3/2021
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