Nevin Manimala

J Surg Educ. 2021 Nov 5:S1931-7204(21)00270-1. doi: 10.1016/j.jsurg.2021.09.023. Online ahead of print.

ABSTRACT

OBJECTIVE: Emotional intelligence (EI) is associated with job success in multiple fields, in part, because EI may mitigate stress and burnout. Research suggests these relationships may include teaching. Our purpose is to further explore the relationships between EI, burnout, and teaching for faculty surgeons.

DESIGN: With IRB approval, surgical faculty were offered the opportunity to complete personal demographics, the Maslach Burnout Inventory, the SETQ-SMART assessment of teaching ability, and the SEF:MED self-assessment of emotional intelligence. Surgical residents rated faculty teaching ability using the SETQ-SMART SETTING: A medium-sized academic medical center in the Southeast approved to graduate 6 residents per year.

PARTICIPANTS: ACGME surgical faculty and general surgical residents PGY1 to PGY5 including preliminary residents, were given the opportunity to participate.

RESULTS: Faculty self-assessed teaching scores were significantly different from resident scores for nine (60%) faculty; three (33%) overrated their and 6 (67%) under rated their overall teaching ability, relative to resident ratings. The 3 SEF:MED scales correlated low-moderate to strongly with the SETQ-OTS: IS (r = 0.41, p = 0.13), EM (r = 0.67, p < 0.01), and EA (r = 0.43, p = 0.11). Overall, 8(53%) faculty scored moderate to high on at least 1 of the 3 MBI subscales. Overall self-rated faculty teaching scores correlated negatively with higher EE and DP and positively with PA (r = -0.08, -0.21, and 0.52, p = 0.047; respectively). EI negatively correlated with MBI-EE and DP and positively with PA (r = -0.31, -0.18, 0.45, respectively), though due to the small sample none reach statistical significance with alpha set to 0.05.

CONCLUSIONS: In this pilot study, EI is positively correlated to surgical faculty members’ teaching ability. Burnout was less strongly correlated with resident-assessed faculty teaching scores, but with similar trends. Finally, EI was correlated with MBI EE, DP, and PA as expected given the literature in other fields. Expanded study is warranted.

PMID:34750078 | DOI:10.1016/j.jsurg.2021.09.023

Urol Oncol. 2021 Nov 5:S1078-1439(21)00446-4. doi: 10.1016/j.urolonc.2021.09.019. Online ahead of print.

ABSTRACT

PURPOSE: Collecting duct carcinoma is a rare pathologic entity with a paucity of clinical data in the literature. We aim to evaluate our institutional experience with the management of this disease.

MATERIALS AND METHODS: All renal tumors in the Mayo Clinic Nephrectomy Registry were re-reviewed retrospectively by an expert urologic pathologist. Cases of collecting duct carcinoma were identified. Descriptive statistics were used to characterize these cases. Overall survival and metastases-free survival were estimated using Kaplan-Meier methodology.

RESULTS: Between 1970 and 2018, a total of 21 cases were identified with an incidence of 0.2%. Cases were seen predominantly in men (N = 17, 81%) with a median age at diagnosis of 57 years old. At the time of nephrectomy, high grade disease (grade 3 or 4) was noted in the majority of patients (90%). The median times to local recurrence and distant metastases were 5.6 and 5.1 months, respectively. Median overall survival occurred at 1.5 years. Median distant metastases-free survival among M0 patients occurred at 0.5 years. Four patients with localized disease and small tumor size who underwent nephrectomy lived longer than 10 years. No systemic therapies achieved a durable response in the metastatic setting.

CONCLUSION: The Mayo Clinic nephrectomy registry contains 21 patients with collecting duct carcinoma over nearly 50 years. Early local recurrence and distant metastases were seen after nephrectomy. However, M0 patients with a small tumor may have long-term benefits from nephrectomy. Neither chemotherapy nor targeted therapy resulted in a durable response in the metastatic setting.

PMID:34750052 | DOI:10.1016/j.urolonc.2021.09.019

Intensive Crit Care Nurs. 2021 Sep 7:103139. doi: 10.1016/j.iccn.2021.103139. Online ahead of print.

ABSTRACT

OBJECTIVES: To provide insights into visiting policies and family-centred care practices with a focus on children as visitors in Intensive Care Units in German-speaking countries.

METHODS/DESIGN: Online-survey with a mixed methods approach. Leading clinicians (n = 1943) from German-speaking countries were invited to participate. Outcomes included the percentage of intensive care units with open visiting policies, age restrictions, family-centred care activities and barriers.

SETTING: Paediatric, mixed and adult units RESULTS: In total, 19.8% (n = 385) of the clinicians responded. Open visiting times were reported by 36.3% (n = 117), with significant differences between paediatric (79.2%), adult (21.3%) and mixed-age (41.2%) units (p < 0.01). Two-thirds of clinicians stated that their units had no age restrictions for children as visitors (n = 221, 68.4%). The family-centred care activities most frequently implemented were open visiting times and dissemination of information. Significantly more German units have open visiting policies and more Swiss units allow children as visitors, compared to the other countries (both p < 0.001). Barriers to family-centred care were concerns about children being traumatized, infection and workload.

CONCLUSION: The majority reported that family-centred care policies had been implemented in their units, including open visiting policies, allowing children as visitors without age restriction and other family-centred care activities.

PMID:34750041 | DOI:10.1016/j.iccn.2021.103139

J Cardiol. 2021 Nov 5:S0914-5087(21)00282-3. doi: 10.1016/j.jjcc.2021.10.011. Online ahead of print.

ABSTRACT

BACKGROUND: The prognostic significance of combining intra-aortic balloon pumping (IABP) with extracorporeal membrane oxygenation (ECMO) for acute myocardial infarction (AMI) patients is still unclear. We investigated whether combining IABP with veno-arterial (VA)-ECMO is associated with a lower risk of short-term mortality.

METHODS: Among 12,093 AMI cases enrolled in the Osaka Acute Coronary Insufficiency Study (OACIS), we identified 519 who were administered VA-ECMO during hospitalization. Among these, 459 received IABP support (IABP group) and 60 cases did not (no-IABP group). The primary endpoint was 30-day all-cause death; the secondary endpoint was major bleeding. Logistic regression analysis using original data was conducted. We also established weighted logistic regression models with inverse probability of treatment weighting (IPTW).

RESULTS: Logistic regression analysis revealed that IABP use was significantly associated with a reduced risk of 30-day death in the original data [odds ratio (OR) 0.504, 95% confidence interval (CI) 0.282-0.901, p = 0.021]. After IPTW-adjustment for clinically relevant covariates with the use of IABP, patients receiving VA-ECMO with IABP had a lower risk of 30-day death (OR 0.816, 95% CI 0.746-0.892, p < 0.001) compared to those without IABP. The incidence of major bleeding was comparable between the groups (IABP 29.0% vs. non-IABP 21.7%, p=0.302). However, the risk of major bleeding was higher in the IABP group after IPTW-adjustment (OR 1.092, 95% CI 1.008-1.184, p=0.032).

CONCLUSIONS: IABP support for AMI patients with VA-ECMO was significantly associated with reduced risk of short-term mortality, suggesting that the addition of IABP support might contribute to improved survival in AMI patients requiring VA-ECMO.

PMID:34750027 | DOI:10.1016/j.jjcc.2021.10.011

Clin Ther. 2021 Nov 5:S0149-2918(21)00388-X. doi: 10.1016/j.clinthera.2021.09.014. Online ahead of print.

ABSTRACT

Real-world data derived from observational studies, particularly from administrative health care and insurance claims databases, are increasingly being used to evaluate treatment effectiveness. To control for potential biases, a number of analytical techniques have been developed. However, the procedures used can be far from intuitive, and this along with other methodological issues can make it challenging to assess whether reported results are real or artefactual. This commentary summarizes some of the issues associated with evaluating treatment effectiveness in the real-world setting, at the same time highlighting the important role observational studies can play.

PMID:34750019 | DOI:10.1016/j.clinthera.2021.09.014

J Thorac Cardiovasc Surg. 2021 Oct 21:S0022-5223(21)01484-7. doi: 10.1016/j.jtcvs.2021.10.015. Online ahead of print.

ABSTRACT

BACKGROUND: Administrative billing data are critical to many initiatives in congenital heart surgery. Mapping algorithms for International Classification of Disease, 10th Revision diagnosis and procedure codes to clinical registry procedure definitions will allow identification of surgical cases and account for patient and procedural factors within administrative data. Our objectives were to develop mapping logic to crosswalk International Classification of Disease, 10th Revision procedure codes to 10 Society of Thoracic Surgeons Congenital Heart Surgery Database benchmark and beta-test the algorithm.

METHODS: Patients undergoing Society of Thoracic Surgeons Congenital Heart Surgery Database benchmark procedures from 2015 to 2019 were identified and served as the gold standard. Cases were linked on direct identifiers to cases from the Pediatric Health Information System Database. Two independent teams developed International Classification of Disease, 10th Revision-based algorithms for cases capture. Algorithms were compared and iteratively refined to optimize sensitivity and specificity. Operative mortalities for cases identified in the administrative versus registry data were compared.

RESULTS: Overall sensitivity was 91% and specificity was 99% for capture of benchmark operations using International Classification of Diseases 10th Revision codes. Sensitivity was more than 90% in identifying 6 of the 10 individual benchmark procedures and more than 98% sensitive in identifying Fontan, Glenn, and arterial switch with ventricular septal defect procedures. Specificity was more than 98% for all benchmark operations. There were no statistical differences in operative mortality between cases identified in the administrative versus the registry data.

CONCLUSIONS: Novel mapping algorithm for International Classification of Disease, 10th Revision procedure codes enables identification of congenital heart benchmark procedures within administrative billing data. This crosswalk facilitates population-based congenital heart surgical research and quality assessment.

PMID:34749937 | DOI:10.1016/j.jtcvs.2021.10.015

Wei Sheng Yan Jiu. 2021 Sep;50(5):821-826. doi: 10.19813/j.cnki.weishengyanjiu.2021.05.019.

ABSTRACT

OBJECTIVE: To study the effects of fine particulate matter(PM_(2.5))exposure to cognitive function and intestinal flora abundance and diversity in adult male mice.

METHODS: The SPF grade male C57 BL/6 J mice with 8 weeks old were randomly divided into control group(NS group), PM_(2.5) exposure group(PM_(2.5) group), probiotic group(VSL#3 group) and PM_(2.5) + VSL#3 group(PMV group), with 8 mice in each group. The PM_(2.5) group and PMV group mice were exposed to PM_(2.5) using animal exposure system equipped with real-time PM_(2.5) concentration, and concentrated 6 times the outdoor PM_(2.5) concentration, 8 h every day, 5 d every week for 4 weeks. The VSL#3 group and PMV group mice were given VSL#3, 0.5 mL, 2×10~9 CFU/mL. After four weeks of exposure, feces from mice were collected for 16 s rRNA high-throughput sequencing, and the cognitive function was evaluated using Morris water maze and object recognition experiments.

RESULTS: The escape latency of PM_(2.5) group in four-day training [(54.99±6.77) s, (41.21±9.98) s, (36.27±13.11) s, (30.01±14.80) s] were higher than that of NS group [(32.19±4.59) s, (20.50±6.77) s, (19.93±7.30) s, (16.94±9.91) s], and the difference were statistically significant(P&lt;0.05). The escape latency of PMV group on the first and second day of training [(39.02±6.23) s, (28.83±9.53) s] were lower than that of PM_(2.5) group(P&lt;0.05). The target quadrant residence time of mice in PM_(2.5) group [(18.30± 8.88) s] was lower than that in NS group and PMV group [(30.53±9.10) s, (30.00±10.61) s]. Compared with NS group(6.09±0.40), the shannon index of PM_(2.5) group and PMV group(5.05±0.65 and 5.46±0.52) were significantly reduced(P&lt;0.05). The target quadrant time was positively correlated with the relative abundance of Actinomyces(r=0.576, P&lt;0.05), and the recognition index was positively correlated with the relative abundance of Firmicutes(r=0.612, P&lt;0.05).

CONCLUSION: PM_(2.5) could lead to cognitive dysfunction in mice, which is related to diversity and abundance of the intestinal flora. Probiotic can improve cognitive function.

PMID:34749878 | DOI:10.19813/j.cnki.weishengyanjiu.2021.05.019

Wei Sheng Yan Jiu. 2021 Sep;50(5):814-820. doi: 10.19813/j.cnki.weishengyanjiu.2021.05.018.

ABSTRACT

OBJECTIVE: To investigate the effects of interleukin-17(IL-17) antibody on polarization of adipose tissue macrophages(ATM) in mice fed with high-fat diet(HFD) exposed to bisphenol A(BPA).

METHODS: Four week-old male C57 BL/6 mice were divided into control group, IgG group, IL-17 antibody group, 1000 nmol/L BPA group, 1000 nmol/L BPA+IgG group, and 1000 nmol/L BPA+IL-17 antibody group according to random number table method. Eight mice per group were fed with HFD and BPA was exposed by drinking water. The IgG group and the 1000 nmol/L BPA+IgG group were intraperitoneally injected with 100 μg IgG antibody once a week, and the IL-17 group and the 1000 nmol/L BPA+IL-17 antibody group were intraperitoneally injected with 100 μg IL-17 antibody once a week. After 16 weeks, the mice were sacrificed, and serum samples were collected for serum separation. Leptin level was measured by enzyme-linked immunosorbent assay(ELISA). The expression of IL-1β, IL-6 and monocyte chemoattractant protein-1(MCP-1)inflammatory cytokines were observed by immunohistochemistry(IHC) of adipose tissue of epididymis. The activity of inducible nitric oxide synthase(iNOS)and arginase-1(Arg-1)was measured by ELISA, and the proportion of M1 and M2 ATMs was measured by flow cytometry(FCM). The expression of CD11 c and CD206 mRNA was measured by qRT-PCR.

RESULTS: Compared with the control group, serum leptin, the expressions of inflammatory cytokines IL-6, IL-1β and MCP-1 in adipose tissue were increased in 1000 nmol/L BPA group, the proportion of M1 type ATM was increased(22.000%±0.500% vs. 31.467%±0.379%), iNOS activity was increased, CD11 c mRNA expression was increased, Arg-1 activity was decreased, CD206 mRNA expression was decreased, the differences were statistically significant(P&lt;0.05), but the proportion of M2 type ATM was decreased insignificantly(P&gt;0.05). There was no significant change in IgG group. Compared with 1000 nmol/L BPA group, IgG+1000 nmol/L BPA group had no significant change. In 1000 nmol/L BPA+IL-17 antibody group, serum leptin was decreased, the expressions of inflammatory factors IL-6, IL-1β and MCP-1 in adipose tissue were down-regulated, and the proportion of M1 type ATM was decreased(31.467%±0.379% vs. 22.933%±0.153%), iNOS activity was decreased, CD11 c mRNA expression was decreased, and the proportion of M2 type ATM was increased(4.847%±0.655% vs. 7.840%±0.555%), Arg-1 activity was enhanced, and CD206 mRNA expression was up-regulated, the differences were statistically significant(P&lt;0.05).

CONCLUSION: IL-17 antibody may reduce the secretion of ATM inflammatory factors by inhibiting the polarization of ATM to M1 type, thus improving the inflammation of adipose tissue in BPA-infected HFD-fed mice.

PMID:34749877 | DOI:10.19813/j.cnki.weishengyanjiu.2021.05.018

Wei Sheng Yan Jiu. 2021 Sep;50(5):781-787. doi: 10.19813/j.cnki.weishengyanjiu.2021.05.013.

ABSTRACT

OBJECTIVE: To investigate the protective effect of oleanolic acid(OA) on HgCl_2 induced liver injury.

METHODS: L02 cells were divided into four groups according to different treatment, control group(Con), oleanolic acid group(OA, 10 μmol/L), HgCl_2 group(HgCl_2, 40 μmol/L) and oleanolic acid + HgCl_2 group(OA + HgCl_2). Cells of control group were given serum-free medium, cells of OA group were pretreated with OA solution for 8 hours, cells of HgCl_2 group were exposed to HgCl_2 solution for 6 hours, cells of OA + HgCl_2 group were pretreated with OA solution for 8 hours, and then exposed to HgCl_2 solution for 6 hours. MTT assay was used to detect cell viability. Laser confocal scanning was used to detect JC-1 probe fluorescence intensity to determine mitochondrial membrane potential. DCFH-DA fluorescence probe combined with flow cytometry was used to detect reactive oxygen species(ROS) level. Annexin V/PI double staining method combined with flow cytometry was used to determine cell apoptosis rate. Catalase(CAT), total superoxide dismutase(T-SOD), glutathione(GSH), malondialdehyde(MDA), Caspase 3 and Caspase 9 kits combined with enzyme labeled instrument were used to determine their activity or content respectively.

RESULTS: Compared with the control group, 40 μmol/L HgCl_2 could significantly reduce cell viability, the level was 0.52±0.03(P&lt;0.05), OA pretreatment could significantly inhibit the decrease of cell viability induced by HgCl_2, the level was 0.86±0.05(P&lt;0.05). The result of mitochondrial membrane potential detection showed that cell exposed to 40 μmol/L HgCl_2 significantly reduced the intensity of red fluorescence, and the ratio of red to green fluorescence was 0.23±0.02(P&lt;0.05). OA pretreatment significantly increased red fluorescence, and the ratio of red fluorescence to green fluorescence was 1.32±0.08, which was significantly higher than that of HgCl_2(P&lt;0.05). After exposure to 40 μmol/L HgCl_2, the relative fluorescence intensity of ROS was 1.21±0.07, the apoptosis rate was about 8%, the activity levels of Casepase 3 and Casepase 9 were 3.11±0.20 and 2.94±0.17, respectively, which were all significantly higher than those in the control group(P&lt;0.05). OA pretreatment could significantly alleviate the changes of the above indexes, and the difference was statistically significant compared with HgCl_2 group(P&lt;0.05). The level of T-SOD in HgCl_2 group was(7.68±0.39)U/mL, which was significantly lower than that in control group(P&lt;0.05). Compared to the control group, the level of MDA was significantly increased to(4.99±0.26)nmol/mg(P&lt;0.05). OA pretreatment significantly increased level of T-SOD and decreased the level of MDA, the levels were(13.97±0.71)U/mL and(3.01±0.17)nmol/mg, respectively(P&lt;0.05).

CONCLUSION: A certain concentration of HgCl_2 can induce hepatocyte damage. OA pretreatment may reduce cell damage by improving oxidative stress.

PMID:34749872 | DOI:10.19813/j.cnki.weishengyanjiu.2021.05.013

Wei Sheng Yan Jiu. 2021 Sep;50(5):769-774. doi: 10.19813/j.cnki.weishengyanjiu.2021.05.011.

ABSTRACT

OBJECTIVE: To study the distribution characteristics of atmospheric pollutants and their correlation with meteorological factors.

METHODS: The PM_(2.5), PM_(10), NO_2, SO_2, O_(3-1 h), O_(3-8 h) and CO daily average concentration data from 2014 to 2020 were obtained from Lanzhou Environmental Protection Bureau. The interannual changes of pollutants, monthly changes, seasonal changes and trend of spatial distribution were analysed. Spearman correlation analysis was performed on the relationship among pollutants.

RESULTS: The main pollutants exceeding the standard in Lanzhou from 2014 to 2020 were PM_(10), PM_(2.5) and NO_2, average annual concentration of PM_(10), PM_(2.5), NO_2 and CO were decreasing year by year, and O_3 was increasing year by year. The monthly average concentration of PM_(10) was the highest in December, January, March and November were the second highest, and it was higher in February, April and May. The monthly change trends of PM_(2.5), NO_2, SO_2 and CO concentrations were the same, and the monthly change trends of the 1 hour average and daily maximum 8-hour average concentrations of O_3 were the same. The seasonal variation of atmospheric pollutant concentration was obvious, the concentrations of PM_(10), PM_(2.5), SO_2, NO_(2 )and CO were the highest in winter and the lowest in summer. O_3 concentration was the highest in summer and lowest in winter. Average annual concentration of 6 pollutants in different regions had statistically significant differences(H=750.40, 1112.99, 1410.05, 352.04, 360.17, 619.20, 729.52; P&lt;0.001). Among them, the average annual concentration of PM_(10), PM_(2.5), SO_(2 )and O_(3-1 h) in Xigu District were the highest. PM_(10), PM_(2.5), NO_2, SO_2, CO average annual concentration were negatively correlated with temperature and wind speed(r_s=-0.423, -0.561, -0.395, -0.660, -0.569, -0.043, -0.094, -0.130, -0.172, -0.135), the concentration of PM_(10), PM_(2.5), O_3, SO_2 concentration were negatively correlated with humidity(r_s=-0.238, -0.121, -0.110, -0.094), only O_3 was positively correlated with temperature(r_s=0.486).

CONCLUSION: The primary pollutants in Lanzhou from 2014 to 2020 were PM_(10), PM_(2.5) and NO_2.O_3 had an obvious upward trend year by year. The 6 pollutants had obvious seasonal changes and regional distribution characteristics. Some pollutants had the same homology, and meteorological factors affected each pollution. The concentration of the substance had an important influence. Relevant air pollution control measures should be formulated based on the main excessive pollutants, the monthly change trend of air pollution and the seasonal pollution characteristics, the same emission sources and geographical distribution characteristics should be considered, and the meteorological factors should be combined.

PMID:34749870 | DOI:10.19813/j.cnki.weishengyanjiu.2021.05.011