Nevin Manimala

Transplant Cell Ther. 2021 Mar;27(3):259.e1-259.e6. doi: 10.1016/j.jtct.2020.12.006. Epub 2020 Dec 16.

ABSTRACT

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) feasibility has increased in the last decades because of haplo-HSCT, changes in chemotherapy schedules, and the possibility of an outpatient-based HSCT. The main barriers remain in low-middle income countries. There is a lack of information regarding haplo-HSCT with a myeloablative (MAC) regimen on an outpatient basis.

OBJECTIVES: Our primary objective was to determine if outpatient haplo-HSCT was feasible.

STUDY DESIGN: Single center, retrospective cohort, n=60 adult patients undergoing Haplo-HSCT. Descriptive statistical analysis, univariate and multivariate comparison.

PATIENTS AND METHOD: We analyzed 60 adult patients transplanted with an intended haplo-HSCT on an outpatient basis from 2015 to 2019 in our unit. A multivariate analysis was performed on risk factors for hospitalization.

RESULTS: Median age was 27 years (15-64). All patients underwent conditioning as outpatients, and none required hospitalization before day 0. Thirteen patients (21.6%) were followed completely in the outpatient clinic and 47 (78.3%) required hospitalization in a median of 3 days after infusion (range, 1-14). The median length of stay (LOS) was 8 days (IQR, 3-17). Fever secondary to cytokine release syndrome (CRS) was the most common reason for hospitalization occurring in 43/47 (91.5%), 4 were related to infection and 36 were related to CRS. In the univariate analysis, CRS, slower engraftment, and female sex were associated with the need for hospitalization. In the multivariate analysis, only CRS remained significant (OR 9.14 [95%CI, 1.58-56.46]). The 2-year overall survival (OS) was 41.7% for ambulatory transplant vs. 38% for those requiring hospitalization (P = 0.12). The 2-year event-free survival (EFS) was 33% for outpatient patients and 16.7% for those hospitalized (log-rank, P = 0.062).

CONCLUSIONS: We demonstrated the feasibility and safety of carrying out an outpatient haplo-HSCT, potentially resulting in cost savings and perhaps a higher quality of life.

PMID:33781529 | DOI:10.1016/j.jtct.2020.12.006

Med Eng Phys. 2021 Apr;90:54-65. doi: 10.1016/j.medengphy.2021.02.007. Epub 2021 Feb 25.

ABSTRACT

Ex vivo analysis of artificial discs is essential to better understand their ability to replace degenerated intervertebral discs. The Mobi-C differs from some other contemporary disc designs in that it has a mobile polyethylene insert that is sandwiched between superior and inferior cobalt chromium endplates. While some studies claim the Mobi-C to have restored normal cervical spinal biomechanics, others have noted high levels of migration. Our objective was to contribute to this debate by, for the first time, analysing an explanted Mobi-C cervical disc which was removed due to worsening myelopathy at the nano and macro scales. Intraoperatively, the insert was found to have excessively migrated and it compressed the spinal cord. Roughness was measured as 0.016 ± 0.006 μm (Sa) and 0.055 ± 0.020 μm (Sa) for the superior and inferior plates, and 1.210 ± 0.154 μm (Sa) and 0.446 ± 0.083 μm (Sa) for the superior and inferior surfaces of the insert. Compared to unworn surfaces, the roughness increased for the superior and inferior plates and decreased for both surfaces of the insert. However, the only statistically significant change occurred on the articulating surface of the inferior plate (p = 0.04). At the nanoscale, valleys dominated the articulating surfaces. The superior plate had a burnished appearance whereas the inferior plate appeared matt. Impingement was observed on the endplates. The insert was severely damaged, burnished and had scratches. Additionally, subsurface whitening and internal cracking were observed on the insert.

PMID:33781480 | DOI:10.1016/j.medengphy.2021.02.007

Med Eng Phys. 2021 Apr;90:1-8. doi: 10.1016/j.medengphy.2021.01.009. Epub 2021 Feb 16.

ABSTRACT

This paper addresses an important issue faced by neurosurgeons during surgical skull bone grinding, a common process used to remove bone in skull base tumour removal surgery to enable the neurosurgeon to reach the target region. The heat generated during bone grinding could harm the soft tissues and can lead to osteonecrosis and cell death. In the present study, a novel process of rotary ultrasonic bone grinding (RUBG) was proposed for osteotomy to limit the temperature to a safe level. A systematic investigation was conducted to determine the effect of varying process parameters on osteonecrosis at the cut surface. Three input parameters – rotational speed, feed rate and frequency – were investigated (at three levels) in terms of change in temperature and thermal biological damage. A sterile solution was used as a coolant to irrigate the grinding zone. Viable lacunae (filled osteocytes), non-viable lacunae (empty lacunae), necrosed tissues, and Haversian canal were found during the histological examination. Statistical analysis revealed that feed rate (45.43%) had the highest contribution towards temperature rise during grinding, followed by ultrasonic frequency (23.87%), and rotational speed (12.85%). The optimal machining parameters to avoid osteonecrosis and thermal trauma were rotational speed 35,000 rpm, feed rate 20 mm/min and ultrasonic frequency 20 kHz. Furthermore, histograms revealed that ultrasonic skull bone grinding was associated with greater cell viability and reduced temperature compared with conventional bone grinding.

PMID:33781475 | DOI:10.1016/j.medengphy.2021.01.009

J Equine Vet Sci. 2021 Apr;99:103397. doi: 10.1016/j.jevs.2021.103397. Epub 2021 Feb 3.

ABSTRACT

In order to evaluate the effect of three different primary vaccination intervals on EI vaccine response, 21 unvaccinated thoroughbred foals were randomly divided into three groups of 7 and vaccinated with three different intervals of primary immunization (i.e., with 1, 2 or 3 months intervals between V1 and V2, respectively). The antibody response was measured for up to 1 year after the third immunization V3 (administered 6 months after V2) by single radial hemolysis (SRH) assay. All weanlings had seroconverted and exceeded the clinical protection threshold 2 weeks after V2 and 1 month after V3 until the end of the study. Significant differences were measured at the peak of immunity after V2 and for the duration of the immunity gap between V2 and V3. The group with one month primary vaccination interval had a lower immunity peak after V2 (158.05 ± 6.63 mm²) and a wider immunity gap between V2 and V3 (18 weeks) when compared with other groups (i.e., 174.72 ± 6.86 mm² and 16 weeks for a two months interval, 221.45 ± 14.48 mm² and 12 weeks for a 3-month interval). The advantage observed in the group with 1 month primary vaccination interval, which induces an earlier protective immunity, is counterbalance with a lower peak of immunity and a wider immunity gap after V2, when compared with foals vaccinated with 2- and 3-month intervals.

PMID:33781435 | DOI:10.1016/j.jevs.2021.103397

J Equine Vet Sci. 2021 Apr;99:103374. doi: 10.1016/j.jevs.2021.103374. Epub 2021 Jan 12.

ABSTRACT

The dynamic upper airway functional (URT) problems of Colombian paso horses (CPH) have not been investigated in literature up to date. These horses perform special walking gaits with high poll flexion of the neck. Our goal is to evaluate the upper airway mechanics in CPH, showing abnormal respiratory sounds and poor performance during exercise. Resting and overground endoscopy was performed in 40 CPHs. Statistical analyses were performed using the sciPy package. One-tailed Fisher exact tests were used to check for positive contingency between each pair of upper respiratory tract disorder (P < .05). Arytenoid cartilage collapse was observed in 35 of 40 cases during exercise. Among these, dynamic laryngeal collapse (DLC) was the most significant finding, but ventromedial luxation of the apex of the corniculate process of the arytenoid and recurrent laryngeal neuropathy was also observed. Dorsal displacement of the soft palate was only detected in 4 of 40 cases. DLC was significantly associated with vocal cord collapse, nasopharyngeal collapse, and medial collapse of the margins of the epiglottis, and medial collapse of the margins of the epiglottis was associated with nasopharyngeal collapse. DLC is only a typical feature in some special breeds worldwide. We suggest that the extensive poll flexion and the relatively small laryngeal lumen and high intensitivity workload are the most important predisposing factors of DLC. Ventromedial luxation of the apex of the corniculate process of the arytenoid was over-represented in our caseload, compared with other studies. Whereas, despite the intensive workload, dorsal displacement of the soft palate was relatively uncommon. We presume that this could also be tailored to the high poll flexion performed during the special gaits.

PMID:33781434 | DOI:10.1016/j.jevs.2021.103374

J Equine Vet Sci. 2021 Apr;99:103359. doi: 10.1016/j.jevs.2020.103359. Epub 2020 Dec 30.

ABSTRACT

This study examined the effects of 15 sessions of hippotherapy (HPOT) on gross motor skills in children (aged 2-3 years) with gross motor developmental delay (DD) (n = 11) in comparison with age-based controls without DD (n = 6). Gross motor skills in both groups were assessed with the Battelle Developmental Inventory 2nd Edition, and gait parameters were measured using a computerized gait analysis system prestudy and poststudy. The DD group took part in 15 sessions of HPOT, and the control (CON) group did not participate in any equine activities. The statistical analysis examined preintervention and postintervention data in the DD group and compared testing data at the same intervals in controls. Functional motor skills significantly improved after HPOT intervention. Mean percent motor delay score decreased by 24.1 points from pretest to post-test in the DD group, indicating significantly (P < .001) less delay after HPOT. In contrast, mean Battelle Developmental Inventory 2nd Edition motor scores of the CON group were unchanged pre-study to post-study. The two groups’ scores were significantly (P < .001) different indicating more improvement in the DD HPOT group when compared with the control group. Gait performance measures did not change significantly (P > .05) from pre-test to post-est in the DD group after HPOT; however, improvement trends were seen in step width and step length after HPOT. The results suggest that HPOT intervention in young children with DD can improve gross motor skills. These data provide important quantitative information concerning the efficacy of early HPOT intervention for children with DD during this critical stage of child development.

PMID:33781428 | DOI:10.1016/j.jevs.2020.103359

J Equine Vet Sci. 2021 Apr;99:103388. doi: 10.1016/j.jevs.2021.103388. Epub 2021 Jan 20.

ABSTRACT

Ill-fitting saddles can impair the well-being and performance of horses. Saddle fit is generally assessed subjectively by a trained professional or with an electronic saddle pressure mat, but little is known about the agreement between both methods. The study aims were (1) to assess the prevalence of saddle fit issues in a riding sound Swiss horse population, (2) to investigate how well the subjective assessment correlates with objectively measured pressure magnitude and distribution under the saddle during riding, and (3) how well both correlate with back pain of the horse. Only 10% of the saddles were free of the assessed problems. Pressures exceeded clinically relevant thresholds in 15% of the horses. There was no clear correlation between back pain and pressure magnitude, but back pain was associated with certain subjectively assessed fit problems. Statistically significant associations between fit problems and the expected pressure patterns were found for panel angles, curvature of the saddle, width of the panel channel, and the waist of the saddle. There was no or limited association of pressure patterns with the balance of the saddle, width and angle of the tree head, or the symmetry of the panels. The results revealed that certain fit problems were reflected in the electronically measured pressure distribution and that the subjective assessment can therefore provide relevant information. Pressure magnitude showed only limited association with back pain, which indicates that there are other factors involved in the development of back problems in horses.

PMID:33781419 | DOI:10.1016/j.jevs.2021.103388

J Equine Vet Sci. 2021 Apr;99:103399. doi: 10.1016/j.jevs.2021.103399. Epub 2021 Feb 3.

ABSTRACT

The use of a self-inflating tissue expander is a technique to stretch cutaneous tissues for potential use in reconstructive skin surgeries. This study investigates the mechanical properties of horse skin stretched by the subcutaneous implantation of anisotropic tissue expanders at the forehead, right shoulder, and dorsomedial part of the cannon region of the right forelimb in six (n = 6) horses. After 14 days of skin expansion, expanded and normal (control) skin samples were harvested and their mechanical properties of elastic modulus (EM), maximum force (MF), maximum stress (MSs) and maximum strain (MSr) were evaluated using uniaxial tension test. The expanded skin from shoulder area has higher EM, MSs, MSr and MF than the normal skin when compared to the forehead and lower forelimb. Statistically, there was a significant (P= .02) mean difference for MSs between the expanded shoulder and lower forelimb skin, but the pairwise comparison of EM, MSr and MF showed no significant difference between the locations. The overall effect of locations on EM and MSs was statistically significant (P < .05), however, there was no overall effect of horse factor, treatment factor (normal and expanded skin) and location interaction on the EM, MSS, MF and MSr. In conclusion, the expanded skin from the frontal head and the distal limb are less elastic (stiffer) compared to that of the expanded skin of the shoulder, thus anatomical location of the skin has some degree of effect on EM and MSs.

PMID:33781409 | DOI:10.1016/j.jevs.2021.103399

Arch Psychiatr Nurs. 2021 Apr;35(2):223-231. doi: 10.1016/j.apnu.2020.06.006. Epub 2020 Jun 16.

ABSTRACT

AIMS: To investigate the well-being at work and analyze relevant predictors of it among nurses working in psychiatric outpatient settings including following specific objectives 1) describe the current state of well-being at work among psychiatric nurses; and 2) examine how background characteristics and exposure to violence predict well-being at work.

DESIGN: A cross-sectional survey design.

METHODS: Two-staged sampling was used to select participants from psychiatric outpatient units. Data were collected with printed Nordic Questionnaire for Monitoring the Age Diverse Workforce (QPSNordic-ADW) and Violence Incidence Assessment (VIA-Q) questionnaire from January 2019 to June 2019. Descriptive statistics were performed to summarize the collected data and binary logistic regression was used to identify predictors related to the well-being at work.

RESULTS: The respondents (n = 181) generally evaluated well-being at work quite positively but were more critical towards interaction with their immediate superior, organizational culture, interaction between work and private life, and organizational commitment. Working experience in psychiatric nursing and experiences of harassment were identified as strong predictors of well-being at work.

CONCLUSION: The management of healthcare organizations should discuss nursing ethics and morale more, as well as pay attention to the ethical environment to prevent moral distress among nurses. Several weaknesses seem to exist especially in the management of psychiatric outpatient units which influence nurses’ well-being at work. Identification of these can help organizations to develop management and implement interventions to increase nurses’ well-being at work. Conversations about the managerial culture and collegial climate should also arise at the organizational and unit levels.

PMID:33781405 | DOI:10.1016/j.apnu.2020.06.006

Arch Psychiatr Nurs. 2021 Apr;35(2):172-177. doi: 10.1016/j.apnu.2021.02.001. Epub 2021 Feb 17.

ABSTRACT

BACKGROUND: The COVID-19 pandemic seriously endangers the public’s mental health, especially to pregnant and postpartum women. But little is known about postpartum depression and health care needs among Chinese postpartum women.

AIM: To investigate the status and risk factors of postpartum depression and health care needs among Chinese postpartum women during the COVID-19 pandemic.

METHODS: In this cross-sectional study, 209 Chinese postpartum women were recruited from May to July 2020 by convenience sampling and assessed online with self-designed Maternal General Information Questionnaire, Edinburgh Postpartum Depression Scale (EPDS) and Chinese Version of the Perceived Stress Scale (CPSS). Descriptive statistics, chi-square test, independent samples t-test, one-way ANOVA, Pearson correlation and multiple linear regression were used for data analysis.

RESULTS: With the EPDS cut-off value of 10, the incidence of postpartum depressive symptoms was 56.9%. Age, history of abortion and perceived stress were the influencing factors of postpartum depression (adjusted R² = 0.432, F = 23.611, p < .001). The top three health care needs were infant rearing guidance (78.0%), maternal and infant protection guidance (60.3%) and dietary guidance (45.0%). The proportion of psychological rehabilitation guidance needs in the depressed group was significantly higher than that in the non-depressed group (34.5% vs. 20.0%, p < .05).

CONCLUSIONS: Maternal postpartum depression in China was at a high level during the COVID-19 pandemic. Women aged 25-34, with a history of abortion and high stress levels were at higher risk for postpartum depression. Timely psychological counselling, intervention and COVID-19-related health education are in great need for postpartum women.

PMID:33781396 | DOI:10.1016/j.apnu.2021.02.001