Category: Nevin Manimala

J Palliat Med. 2021 Mar 5. doi: 10.1089/jpm.2020.0358. Online ahead of print.

ABSTRACT

Background: Health professionals who care for patients and their families at the end of life (EOL) may experience gratitude, and enhanced spirituality and meaning in life, yet they are also at increased risk of psychological distress, compassion fatigue, and occupational burnout given the stressors they encounter in their work. Objectives: This research evaluated the feasibility and acceptability of a novel six-week mindfulness-based compassion training intervention, which was tailored to health professionals involved in EOL care (“MBCT4HP”), and explored its impact on levels of psychological distress, compassion fatigue, compassion satisfaction, occupational burnout, self-compassion, and mindfulness. Design: We adopted an observational, repeated measures pilot study. Setting/Subjects: Thirty-one health professionals participated. The intervention comprised six, weekly sessions (totaling seven hours) designed to foster compassion for self and others, including formal and informal compassion and mindfulness practices, daily home practice, and a reflective experiential pedagogy. Measurements: Validated outcome measures for anxiety, depression, and stress; compassion satisfaction, compassion fatigue (burnout, secondary traumatic stress); occupational burnout (emotional exhaustion, personal accomplishment, and depersonalization), self-compassion, and mindfulness were administered at baseline, end of intervention, and eight weeks postintervention. The feasibility and acceptability of the intervention was assessed using attendance records, home practice logs, and self-report satisfaction items. Descriptive statistics and Generalized Linear Mixed Models were used to analyze the data. Results: Participants reported that the sessions were useful, relevant, easy to understand, and that they gave them sufficient knowledge to implement the strategies learned. Levels of anxiety, compassion fatigue (burnout only), and emotional exhaustion decreased over time with some decay in effects at follow up, and levels of compassion satisfaction and self-compassion increased with time. Conclusions: The intervention was feasible and acceptable to health professionals involved in EOL care and had a positive impact on levels of anxiety, compassion fatigue (burnout), emotional exhaustion, compassion satisfaction, and self-compassion.

PMID:33666500 | DOI:10.1089/jpm.2020.0358

J Laparoendosc Adv Surg Tech A. 2021 Mar 5. doi: 10.1089/lap.2021.0016. Online ahead of print.

ABSTRACT

Purpose: To compare and analyze the incidence of postoperative reflux esophagitis (RE) in patients with early- and intermediate-stage proximal gastric cancer after proximal gastrectomy plus esophagus-remnant stomach anterior wall anastomosis with proper spacing between the reserved anastomotic stoma and the stump of the remnant stomach versus total gastrectomy plus Roux-en-Y anastomosis and to analyze the advantages and disadvantages of these anastomosis approaches. Methods: Hospitalization data of 23 patients with early- and intermediate-stage proximal gastric cancer were retrospectively analyzed. They were divided into an observation group who underwent proximal gastrectomy plus esophagus-remnant stomach anterior wall anastomosis with proper spacing between the reserved anastomotic stoma and the stump of the remnant stomach and a control group who underwent total gastrectomy plus Roux-en-Y anastomosis. Quality observation indicators were compared between the two groups. Results: There was no statistically significant difference between the groups in the number of lymph nodes cleared or the recurrence rate at 12 months postoperatively. The incidence of postoperative RE was significantly lower in the observation group (25%) than in the control group (80%). The operation time, postoperative length of hospital stay, appetite change, body mass index, and hemoglobin level at 6 months postoperatively were significantly better in the observation group than in the control group (P < .05). Conclusion: Proximal gastrectomy plus esophagus-remnant stomach anterior wall anastomosis with proper spacing between the reserved anastomotic stoma and the stump of the remnant stomach can be used as a preferred surgical procedure for early- and mid-stage proximal gastric cancer.

PMID:33666512 | DOI:10.1089/lap.2021.0016

Expert Rev Med Devices. 2021 Mar 5. doi: 10.1080/17434440.2021.1899805. Online ahead of print.

ABSTRACT

INTRODUCTION: Energy-based devices are widely used in thyroid surgery in order to achieve optimal hemostasis, while their role in the incidence of hypocalcemia and hypoparathyroidism comprises a topic evaluated in numerous studies.

AREAS COVERED: The aim of this systematic review is to investigate the potential benefit of Ultrasonic Shears and Electrothermal Bipolar (Radiofrequency) System in thyroid surgery regarding the incidence of post-operative hypocalcemia and hypoparathyroidism. A systematic review of the literature in PubMed/Medline and Scopus databases was conducted. 49 studies met the inclusion criteria and were analyzed. A statistically decreased rate of transient hypocalcemia and hypoparathyroidism were reported in 15 studies and 4 studies respectively, when using energy-based devices. However, 18 and 13 surveys examined transient hypocalcemia and hypoparathyroidism respectively and demonstrated no statistical difference between energy-based devices and conventional hemostasis. No difference was observed between the groups concerning permanent hypocalcemia. Out of 13 studies, only 2 showed a significant reduction in the occurrence of permanent hypoparathyroidism in the energy-based device group.

EXPERT OPINION: Energy-based devices reduced the rate of transient hypocalcemia and hypoparathyroidism after thyroid surgeries in 42.8% and 23.5% of the included studies respectively. Further studies are needed to evaluate their impact on permanent post-operative hypocalcemia and hypoparathyroidism.

PMID:33666537 | DOI:10.1080/17434440.2021.1899805

SICOT J. 2021;7:7. doi: 10.1051/sicotj/2021002. Epub 2021 Mar 5.

ABSTRACT

BACKGROUND: Identifying the risk factors for the neurological deficit in spine tuberculosis would help surgeons in deciding on early surgery, thus reducing the morbidity related to neurological deficit. The main objective of our study was to predict the risk of neurological deficit in patients with spinal tuberculosis (TB).

METHODS: The demographic, clinical, radiological (X-ray and MRI) data of 105 patients with active spine TB were retrospectively analyzed. Patients were divided into two groups – with a neurological deficit (n = 52) as Group A and those without deficit (n = 53) as Group B. Univariate and multivariate logistic regression analysis was used to predict the risk factors for the neurological deficit.

RESULTS: The mean age of the patients was 38.1 years. The most common location of disease was dorsal region (35.2%). Paradiscal (77%) was the most common type of involvement. A statistically significant difference (p < 0.05) was noted in the location of disease, presence of cord compression, kyphosis, cord oedema, loss of CSF anterior to the cord, and degree of canal compromise or canal encroachment between two groups. Multivariate analysis revealed kyphosis > 30° (OR – 3.92, CI – 1.21-12.7, p – 0.023), canal encroachment > 50% (OR – 7.34, CI – 2.32-23.17, p – 0.001), and cord oedema (OR – 11.93, CI – 1.24-114.05, p – 0.03) as independent risk factors for predicting the risk of neurological deficit.

CONCLUSION: Kyphosis > 30°, cord oedema, and canal encroachment (>50%) significantly predicted neurological deficit in patients with spine TB. Early surgery should be considered with all these risk factors to prevent a neurological deficit.

PMID:33666548 | DOI:10.1051/sicotj/2021002

Brain Behav. 2021 Mar 5:e02038. doi: 10.1002/brb3.2038. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to identify the determinants of cognitive dysfunction and compare the effect of CPZ and LTC on cognition in WWE.

METHODS: An observational study involving 87 consenting adult WWE aged between 16 and 40 years on LTC or CZP monotherapy. At enrollment, an interviewer-based questionnaire was used to obtain demographic and clinical information from participants. The diagnosis of epilepsy was mainly clinical and supported by electroencephalographic (EEG) features and classified based on recommendation by the 2017 International League Against Epilepsy (ILAE). Zung Self-Reporting Depression Scale (ZSRDS) was used to assess the mood of participants. The Community Screening Interview for Dementia (CSID) was used to assess various cognition domains. The National Hospital Seizure Severity Scale (NHS-3) was used to assess disease severity.

RESULTS: There were statistical differences between the CZP and LTC groups in all domains of cognition assessed except for orientation. The total CSID scores of the LTC group were 59.2 (4.9) as opposed to CZP group, 57.2 (5.0); p: .005. Those with focal onset seizures had lower median total CSID score (58; IQR: 54-62) when compared to those with generalized onset seizures (62; IQR: 58-62), p: .012. There was a significant correlation between ZSRD score and NHS-3 score; rho: 0.30, p: .007. Bivariate analysis shows statistically significant correlation between total CSID score and ZSRDS (rho: -0.65), BMI (rho: 0.22), and NHSS-3 score (rho: -0.36), respectively. However, the effect of AED on CSID scores was lost after multivariate quantile regression with only ZSRDS retaining significance.

CONCLUSION: Depression, seizure severity, type and structural etiology were associated with cognitive impairment among WWE. However, on regression model, only depression was statistically significant. The presence of more risks for cognitive impairment in the CZP group limits possible conclusion of LTC superiority.

PMID:33666367 | DOI:10.1002/brb3.2038

Anal Chem. 2021 Mar 5. doi: 10.1021/acs.analchem.0c05206. Online ahead of print.

ABSTRACT

Plasmonic nanostructure-enabled label-free surface-enhanced Raman spectroscopy (SERS) emerges as a rapid nondestructive molecular fingerprint characterization technique for complex biological samples. However, label-free SERS bioanalysis faces challenges in reliability and reproducibility due to SERS signals’ high susceptibility to local optical field variations at plasmonic hotspots, which can bias correlations between the measured spectroscopic features and the actual molecular concentration profiles of complex biochemical matrices. Herein, we report that plasmonically enhanced electronic Raman scattering (ERS) signals from metal nanostructures can serve as a SERS calibration internal standard to improve multivariate analysis of living biological systems. Through side-by-side comparisons with noncalibrated SERS datasets, we demonstrate that the ERS-based SERS calibration can enhance supervised learning classification of label-free living cell SERS spectra in (1) subtyping breast cancer cells with different degrees of malignancy and (2) assessing cancer cells’ drug responses at different dosages. Notably, the ERS-based SERS calibration has the advantages of excellent photostability under laser excitation, no spectral interference with biomolecule Raman signatures, and no occupation competition with biomolecules at hotspots. Therefore, we envision that the ERS-based SERS calibration can significantly boost the multivariate analysis performance in label-free SERS measurements of living biological systems and other complex biochemical matrices.

PMID:33666427 | DOI:10.1021/acs.analchem.0c05206

J Phys Chem Lett. 2021 Mar 5:2489-2495. doi: 10.1021/acs.jpclett.1c00085. Online ahead of print.

ABSTRACT

The phosphinidenesilylene (HPSi; X¹A’) molecule was prepared via a directed gas-phase synthesis in the bimolecular reaction of ground-state atomic silicon (Si; ³P) with phosphine (PH₃; X¹A₁) under single-collision conditions. The chemical dynamics are initiated on the triplet surface via addition of a silicon atom to the non-bonding electron pair of phosphine, followed by non-adiabatic dynamics and surface hopping to the singlet manifold, accompanied by isomerization via atomic hydrogen shift and decomposition to phosphinidenesilylene (HPSi, X¹A’) along with molecular hydrogen. Statistical calculations predict that silylidynephosphine (HSiP, X¹Σ⁺) is also formed, albeit with lower yields. The barrier-less route to phosphinidenesilylene opens up a multipurpose mechanism to access the hitherto obscure class of phosphasilenylidenes through silicon-phosphorus coupling via reactions of atomic silicon with alkylphosphines under single-collision conditions in the absence of successive reactions of the reaction products, which are not feasible to prepare by traditional synthetic routes.

PMID:33666441 | DOI:10.1021/acs.jpclett.1c00085

Phys Rev Lett. 2021 Feb 19;126(7):079901. doi: 10.1103/PhysRevLett.126.079901.

ABSTRACT

This corrects the article DOI: 10.1103/PhysRevLett.125.048102.

PMID:33666493 | DOI:10.1103/PhysRevLett.126.079901

J Med Virol. 2021 Mar 5. doi: 10.1002/jmv.26918. Online ahead of print.

ABSTRACT

Here we analyze hospitalized and ICU COVID-19 patient outcomes from the international VIRUS registry (https://clinicaltrials.gov/ct2/show/NCT04323787). We find that COVID-19 patients administered unfractionated heparin but not enoxaparin have a higher mortality-rate (390 of 1,012 = 39%) compared to patients administered enoxaparin but not unfractionated heparin (270 of 1,939 = 14%), presenting a risk ratio of 2.79 (95% C.I.: [2.42, 3.16]; p-value: 4.45e-52). This difference persists even after balancing on a number of covariates including demographics, comorbidities, admission diagnoses, and method of oxygenation, with an increased mortality rate on discharge from the hospital of 37% (268 of 733) for unfractionated heparin vs. 22% (154 of 711) for enoxaparin, presenting a risk ratio of 1.69 (95% C.I.: [1.42, 2.00]; p-value: 1.5e-8). In these balanced cohorts, a number of complications occurred at an elevated rate for patients administered unfractionated heparin compared to patients administered enoxaparin, including acute kidney injury, acute cardiac injury, septic shock, and anemia. Furthermore, a higher percentage of Black/African American COVID patients (414 of 1,294 [32%]) were noted to receive unfractionated heparin compared to White/Caucasian COVID patients (671 of 2,644 [25%]), risk ratio 1.26 (95%CI [1.14, 1.40], p-value: 7.5e-5). After balancing upon available clinical covariates, this difference in anticoagulant use remained statistically significant (311 of 1,047 [30%] for Black/African American vs. 263 of 1,047 [25%] for White/Caucasian, p-value: 0.02, risk ratio 1.18, 95%CI [1.03, 1.36]). While retrospective studies cannot suggest any causality, these findings motivate the need for follow-up prospective research into the observed racial disparity in anticoagulant use and outcomes for severe COVID-19 patients. This article is protected by copyright. All rights reserved.

PMID:33666246 | DOI:10.1002/jmv.26918

Dig Endosc. 2021 Mar 5. doi: 10.1111/den.13965. Online ahead of print.

ABSTRACT

OBJECTIVES: A single-use duodenoscope (SUD) has been recently developed to overcome issues with ERCP-related cross-infections. The aim was to evaluate SUD safety and performance in a prospective multi-centre study.

METHODS: All consecutive patients undergoing ERCP in six French centres were prospectively enrolled. All procedures were performed with the SUD; in case of ERCP failure, operators switched to a reusable duodenoscope. Study outcomes were the successful completion of the procedure with SUD, safety and operators’ satisfaction based on a VAS 0-10 and on 22 qualitative items. The study protocol was approved by French authorities and registered (ID-RCB: 2020-A00346-33). External companies collected the database and performed statistical analysis.

RESULTS: Sixty patients (34 females, median age 65.5-year-old) were enrolled. Main indications were bile duct stones (41.7%) and malignant biliary obstruction (26.7%). Most ERCP were considered ASGE grade 2 (58.3%) or 3 (35.0%). Fifty-seven (95.0%) procedures were completed using the SUD. Failures were unrelated to SUD (1 duodenal stricture, 1 ampullary infiltration, and 1 tight biliary stricture) and could not be completed with reusable duodenoscopes. Median operators’ satisfaction was 9 (7-9). Qualitative assessments were considered clinically satisfactory in a median of 100% of items and comparable to a reusable duodenoscope in 97.9% of items. Three patients (5%) reported an AE. None was SUD-related.

CONCLUSIONS: The use of a SUD allows ERCP to be performed with an optimal successful rate. Our data show that SUD could be used for several ERCP indications and levels of complexity.

PMID:33666280 | DOI:10.1111/den.13965