Category: Nevin Manimala

Surg Infect (Larchmt). 2021 May 26. doi: 10.1089/sur.2020.397. Online ahead of print.

ABSTRACT

Background: The role of negative pressure wound therapy (NPWT) in the management of open chest wounds is unclear. Our aim was to determine the safety and efficacy of NPWT compared with conventional therapy for open chest wounds. Methods: Ten patients with infected open chest wounds were included in a prospective trial of NPWT after surgical debridement. Their outcomes were compared with those of 11 control patients treated during the same period with surgical debridement and open chest packing only. The control group data were obtained by retrospective review of medical records. Results: The median duration of NPWT was eight days (range 2-29 days), with closure in eight patients (80%). Two patients having NPWT had unveiling of occult pleural fistulas leading to early discontinuation. The patients having NPWT had a shorter median time to closure (7 versus 18 days; p = 0.071) and shorter initial (median 6 versus 20 days; p = 0.026) and total (median 6 versus 25 days; p = 0.024) hospital length of stay. Control patients had higher rates of new-onset atrial fibrillation (46% versus 0; p = 0.035) and septic shock (64% versus 10%; p = 0.024). The chest was either closed or healing at the time of the last visit in 100% of the NPWT patients versus 73% of control patients (p = 0.28). The 1-year survival estimates were 90% for the NPWT patients and 80% for the control patients (p = 0.69). Conclusion: Negative pressure wound therapy is feasible and safe for open infected chest wounds in selected patients compared with open packing alone and may reduce hospital stay duration and major complication rates.

PMID:34042543 | DOI:10.1089/sur.2020.397

Expert Opin Drug Saf. 2021 May 27. doi: 10.1080/14740338.2021.1935864. Online ahead of print.

ABSTRACT

BACKGROUND: Dalbavancin is a semisynthetic lipoglycopeptide antimicrobial agent with activity against Gram-positive bacteria including anaerobes.

RESEARCH DESIGN AND METHODS: Meta-analysis of randomized control trials and large case series (more than 20 patients), were identified by searching Pubmed and Cochrane databases through December 14, 2020.

RESULTS: 3,073 patients from 6 RCTs met the inclusion criteria in acute bacterial skin and skin-structure infections, catheter-related infections and osteomyelitis. Treatment emergent adverse effects were described in 30.6% dalbavancin patients, and 38.1% patients with other treatments. Our meta-analysis supports favorable results for dalbavancin treatment (OR 0.79; 95%CI 0.66-0.94; p = 0.01). 2.74% dalbavancin patients had to discontinue treatment versus 2.49% patients on other antibiotics. 4.80% dalbavancin patients versus 5.30% patients with other treatments had severe adverse events. 0.31% in the dalbavancin group and 0.95% receiving other antibiotics died. There was no statistically significant difference in severe adverse effects with OR 0.77; 95% CI 0.52-1.14; p=0.19. Dalbavancin therapy was shown to have statistically significant lower mortality rate (OR 0.26; 95% CI 0.07-0.90; p = 0.03). Observational studies reported few side effects but included a heterogeneous population of patients concerning their diagnosis and the duration of antibiotic treatment.

CONCLUSIONS: Dalbavancin has comparable safety profile relative to other antibiotics and is well-tolerated.

PMID:34042549 | DOI:10.1080/14740338.2021.1935864

J Palliat Med. 2021 May 25. doi: 10.1089/jpm.2019.0563. Online ahead of print.

ABSTRACT

Background: Physician Assistants (PAs) are increasingly likely to work in clinical areas where family conference skills are needed, but there is currently a lack of family conference education in PA program curricula. Objectives: To (1) describe a novel interprofessional education (IPE) event for PA students and chaplain residents; (2) examine whether participating in the IPE event is associated with improvements in attitudes and knowledge regarding interprofessional teams; and (3) describe participant perceptions about the event. Design: Two cohorts of PA students and chaplain residents completed a required interprofessional simulation activity involving a critically ill patient and a family conference. All participants completed pre- and postsimulation activity questionnaires. Bivariate tests were utilized to analyze the quantitative data. Setting/Subjects: Over two years, 171 PA students and 20 chaplain residents completed the activity at a school of medicine in the United States. Measurements: Pre- and postactivity measurements included role-specific questions plus overlapping sections regarding roles and responsibilities of the other discipline, comfort facilitating end-of-life discussions, and the value of IPE. Results: For PA students, there was a statistically significant increase for all questionnaire items. The largest effect size increases were in PA students’ confidence in provider-patient communication at the end of life (Cohen’s d > 1.1). Chaplain data demonstrated increases in knowledge of the PA role and likelihood of consulting with PAs in the future. Conclusion: This simulation event improved participant attitudes and knowledge relating to interprofessional interactions in the setting of an end-of-life family conference, and may contribute to more effective collaboration between PAs and chaplains in the clinical setting.

PMID:34042524 | DOI:10.1089/jpm.2019.0563

Neuroradiol J. 2021 May 27:19714009211019380. doi: 10.1177/19714009211019380. Online ahead of print.

ABSTRACT

BACKGROUND: The internal maxillary artery and extracranial middle meningeal artery are vitally important. Anatomical studies of the relationship of between them using computed tomography angiography are rare.

MATERIAL AND METHODS: This study assessed 75 cases involving 150 sides. And the vascular diameters and lengths of the internal maxillary artery and middle meningeal artery were measured using a GE workstation. The distance between the zygomatic arch midpoint and the internal maxillary artery, the angle between the internal maxillary artery and middle meningeal artery were measured, and the middle meningeal artery branch and internal maxillary artery aneurysm were recorded. The internal maxillary artery course classifications were recorded. All of these parameters were statistically analysed.

RESULTS: Ages ranged from 18 to 72 (average 40.2) years, and there were 30 women (40%, 30/75) and 45 men (60%, 45/75). Internal maxillary artery length from its origin to middle meningeal artery origin was 1.37 ± 0.59 cm. The extracranial middle meningeal artery length was 1.79 ± 0.48 cm. The vessel diameters of internal maxillary artery origin, middle meningeal artery origin, and middle meningeal artery at the skull base were 2.93 ± 0.52 mm, 1.58 ± 0.43 mm, and 1.33 ± 0.43 mm, respectively. Among the 150 sides of internal maxillary artery course type, there were 138 superficial (92%, 138/150) and 12 (8%, 12/150) deep course cases. The angle between the internal maxillary artery and middle meningeal artery was 116.2 ± 35.76°.

CONCLUSIONS: The findings of this study elucidate the imaging features of the internal maxillary artery and extracranial middle meningeal artery and their relationships, which are helpful for the extracranial-intracranial bypass and endovascular treatment via the internal maxillary artery and middle meningeal artery.

PMID:34042531 | DOI:10.1177/19714009211019380

Can J Nurs Res. 2021 May 27:8445621211014421. doi: 10.1177/08445621211014421. Online ahead of print.

ABSTRACT

OBJECTIVES: The study aimed to describe and compare nurses’ perceptions of role conflict by professional designation [registered nurse (RN) vs registered practical nurse (RPN)] in three primary areas of practice (emergency department, medical unit, and surgical unit).

METHODS: This analysis used data (n = 1,981) from a large cross-sectional survey of a random sample of RNs and RPNs working as staff nurses in acute care hospitals in Ontario, Canada. Role conflict was measured by the Role Conflict Scale.

RESULTS: A total of 1,981 participants (RN = 1,427, RPN = 554) met this study’s eligibility criteria and provided complete data. In general, RN and RPN mean total scale scores on role conflict hovered around the scale’s mid-point (2.72 to 3.22); however, RNs reported a higher mean score than RPNs in the emergency department (3.22 vs. 2.81), medical unit (2.95 vs 2.81) and surgical unit (2.90 vs 2.72). Where statistically significant differences were found, the effect sizes were negligible to medium in magnitude with the largest differences noted between RNs and RPNs working in the emergency department.

CONCLUSIONS: The results suggest the need to implement strategies that diminish role conflict for both RNs and RPNs.

PMID:34042538 | DOI:10.1177/08445621211014421

Environ Sci Technol. 2021 May 27. doi: 10.1021/acs.est.1c01167. Online ahead of print.

ABSTRACT

In highly industrialized, densely populated parts of Central Europe, mobilization of legacy Zn pollution from forest ecosystems may negatively affect the quality of water resources. To test this hypothesis, we determined the ⁶⁶Zn/⁶⁴Zn isotope ratios of 15 Zn reservoirs and fluxes in an acidified, spruce die-back affected mountain-slope catchment in northern Czech Republic. The δ⁶⁶Zn values of precipitation, organic horizon, and runoff were statistically indistinguishable. In contrast, δ⁶⁶Zn values of bedrock orthogneiss and mineral soil were significantly different from δ⁶⁶Zn values of runoff. The magnitude of within-site Zn isotope fractionations appeared to be relatively small. Despite the large potential source of Zn in bedrock, runoff exported mostly young pollutant Zn that had been temporarily stored in the organic horizon. This conclusion was corroborated by comparing Zn input-output mass balances in the polluted northern catchment and in a relatively unpolluted catchment situated 250 km to the south. Seven-times higher Zn export via runoff at the northern site was controlled by a combination of 10-times higher atmospheric Zn input and five-times higher DOC leaching, compared to the southern site. In industrial areas, atmospherically deposited Zn is leached from headwater catchments in a direct analogy to leaching of highly toxic pollutant Pb.

PMID:34042419 | DOI:10.1021/acs.est.1c01167

Genet Test Mol Biomarkers. 2021 May 27. doi: 10.1089/gtmb.2020.0342. Online ahead of print.

ABSTRACT

Background: The aim of this study was to investigate associations between polymorphisms in the Lysyl oxidase (LOX) gene with susceptibility to cancer. The role of LOX in carcinogenesis prompted several association studies in various cancer types; however the outcomes of these studies have inconsistent. Thus, we performed a meta-analysis to obtain more precise estimates. Materials and Methods: A literature search yielded 14 articles from which we examined five cancer groups: breast, bone, lung, gastrointestinal, and gynecological cancers. For each cancer group, pooled odds ratios (ORs) and confidence intervals (95% CIs) were calculated using standard genetic models. High significance (p-value for association [p^a] < 0.00001), homogeneity (I² = 0%), and high precision of effects (CI difference [CID] <1.0 [upper CI – lower CI]) comprised the three criteria for strength of evidence. We used sensitivity analysis to assess robustness of the outcomes. Results: We generated 28 comparisons from which 13 were significant (p^a < 0.05), indicating increased risk, (OR >1.00) found in all cancer groups except breast (p^a = 0.10-0.91). Of the 13, three met all criteria (core) for strength of evidence (p^a < 0.00001, CIDs 0.49-0.56 and I² = 0%), found in dominant/codominant models of gynecological cancers (ORs 1.52-1.62, 95% CIs 1.26-1.88) and codominant model of lung cancer (OR 1.44, 95% CI 1.19-1.74). These three were deemed robust. Conclusion: Based on the three core outcomes, associations of LOX 473G/A with lung, ovarian, and cervical cancers indicate 1.4-1.6-fold increased risks, underpinned by robustness and high statistical power at the aggregate level.

PMID:34042515 | DOI:10.1089/gtmb.2020.0342

Ying Yong Sheng Tai Xue Bao. 2021 May;32(5):1673-1680. doi: 10.13287/j.1001-9332.202105.005.

ABSTRACT

Using DC3 high-resolution dendrometer and Granier-type thermal dissipation probes, we measured stem diameter micro-variations and xylem sap flow of two typical forestation species, Quercus liaotungensis and Robinia pseudoacacia, for a growing season in the loess hilly region of China. The main environmental factors (soil water content, solar radiation, air temperature and relative humidity) were monitored. The linkage between diameter micro-variations and transpiration water use were analyzed with respect to their responses to environmental factors. The results showed that the variations in stem diameter and sap flux density of both species had obvious diurnal rhythms. The maximum daily shrinkage was positively correlated with daily sap flux density. The micro-variation of stem diameter at the daily scale was affected by transpiration during the day. The maximum daily shrinkage of stem diameter was positively correlated and well fitted with transpiration driving factors (solar radiation, vapor pressure deficit, and the integrated variable VT). The difference in slopes of regression curves suggested that the daily variation of stem diameter in Q. liaotungensis was greater and more sensitive to meteorological factors than that in R. pseudoacacia. The sap flux densities of both tree species were higher during the period with relatively higher soil water content than that with lower soil water content. The difference of maximum daily diameter shrinkage between different soil water conditions was statistically significant in Q. liaotungensis, but not in R. pseudoacacia. These differences may be related to water use strategies, including transpiration regulation and stem water replenishment.

PMID:34042361 | DOI:10.13287/j.1001-9332.202105.005

Ying Yong Sheng Tai Xue Bao. 2021 May;32(5):1717-1725. doi: 10.13287/j.1001-9332.202105.010.

ABSTRACT

The statistical model (log-normal model), niche models (Zipf model, broken stick mo-del, niche preemption model), and neutral model were used to fit the species-abundance distribution patterns based on the measurements of environmental factors and inventory data of trees with DBH≥1 cm in a 1.5 hm² plot in the primary forest (PF) and a 1.5 hm² plot in the secondary forest (SF). The results showed that species-abundance distribution was affected by habitat heterogeneity in Q. aliena var. acutiserrata forest. Topography had a predominant impact on the species-abundance distribution in PF. Species distribution was affected by both neutral and niche processes, with neutral process having a less prominent effect in large convexity habitats. While the neutral model was rejected by the K-S and Chi-square test in low convexity habitats, the species-abundance distribution satisfied the assumption of niche theory. Niche process and neutral process were equally important in the community in areas with steep slopes, while niche differentiation was the dominant in flat areas. In SF, the main factors affecting species distribution were soil nutrients. The niche process was the mainly ecological process affected species-abundance distribution in habitats with high soil available phosphorus, while the niche and neutral processes existed simultaneously in habitats with low soil phosphorus availability. There was a significant scale effect on the species-abundance distribution pattern of Q. aliena var. acutiserrata forests in Taibai Mountain. The niche and neutral processes could protect the species-abundance distribution at the 20 m×20 m scale in PF, while the niche process could explain the species-abundance distribution at the 40 m×40 m and 70 m×70 m scales. The niche and neutral processes combined acted on the species abundance distribution at the 20 m×20 m, 40 m×40 m and 70 m×70 m scales in SF, with niche process being more important than neutral process. Moreover, besides the scale and habitat heterogeneity, the species-abundance distribution patterns of Q. aliena var. acutiserrata forests differed significantly between primary forest and secondary forest under anthropogenic disturbance.

PMID:34042366 | DOI:10.13287/j.1001-9332.202105.010

Eur J Phys Rehabil Med. 2021 May 27. doi: 10.23736/S1973-9087.21.06789-7. Online ahead of print.

ABSTRACT

BACKGROUND: Surgery for Non Small Cell Lung Cancer is proven to be the most effective treatment in early stages, although concerns exist on its negative impact on patients’ overall fitness.

AIM: To establish whether intensive pulmonary rehabilitation, preoperative and postoperative, improves exercise capacity in patients undergoing lung resection.

DESIGN: Single centre, unblinded, designed for superiority, 1:1 randomised controlled trial with two parallel arms.

SETTING: S.Maria Nuova Hospital of Reggio Emilia (Italy).

POPULATION: Patients referred from local lung cancer multi-disciplinary team for lung resection.

METHODS: Patients were randomised to either standard of care (SC) or SC + intensive perioperative pulmonary rehabilitation (SC+PR). The primary aim was to investigate the effectiveness of pulmonary rehabilitation in improving exercise capacity six months after surgery. Additionally, we wanted to investigate the same effect shortly after surgery (at one month), as well as the overall impact of rehabilitation on lung function, postoperative complications and length of stay, Quality of Life, mood disturbances and pain. Sample was sized based on the primary outcome assuming a minimal clinically significant difference of 25 metres in exercise tolerance, measured with 6 minutes walking test.

RESULTS: The exercise tolerance at 6 months after surgery was significantly higher in patients undertaking PR compared to SC (+48.9 metres vs -7.5 metres respectively, difference: +56.4 metres, 95% CI: 29.6 – 83.0, p<0.001) and it showed significantly lower impairment at 1 month after surgery in the intervention group (-3.0 metres vs -30.1 metres difference: +27.1 metres, 95% CI: 3.4 – 50.8, p=0.025). No other significant differences between groups were found.

CONCLUSIONS: Comparison between groups showed that pulmonary rehabilitation, administered pre and postoperatively, significantly improved exercise capacity at 6 months in patients undergoing lung resection; it also significantly reduced the decrease in exercise tolerance observed 1 month after surgery.

CLINICAL REHABILITATION IMPACT: The PUREAIR trial highlights the importance of combined pre-operative and post-operative rehabilitation in reducing physical deconditioning in lung cancer patients undergoing surgery. Comprehensive pulmonary rehabilitation improves exercise capacity at 1 and 6 months after surgery. The PUREAIR trial results increase knowledge on comprehensive rehabilitation’s outcomes in the first six months after surgery.

PMID:34042410 | DOI:10.23736/S1973-9087.21.06789-7