Nevin Manimala

Hemodial Int. 2021 Mar 21. doi: 10.1111/hdi.12926. Online ahead of print.

ABSTRACT

INTRODUCTION: Job burnout is an occupational psychological syndrome with a high prevalence among nurses in China. Hemodialysis (HD) nursing work has the characteristics of high intensity, high technical content, and high risk. The aims of this study were to investigate the prevalence and level of job burnout among HD nurses in China and explore the potential factors associated with burnout among HD nurses.

METHODS: This was a cross-sectional study in 2019. Survey data were collected from 2738 HD centers in mainland China. Job burnout was measured by the Chinese version of the Maslach Burnout Inventory. The working atmosphere, interpersonal relationships with colleagues, and intention to leave were each assessed by a single question respectively. Multiple linear regression and structural equation modeling were used for the analysis.

FINDINGS: A total of 10,570 surveys were collected. A total of 1199 (11.34%) HD nurses reported a high level of emotional exhaustion, 782 (7.40%) reported a high level of depersonalization, and 6767 (64.02%) reported a low level of personal accomplishment. Job burnout in the Northeastern region of mainland China was higher than that in other regions (p < 0.05). The working atmosphere, interpersonal relationships, region, hospital level, educational level, career planning, age, and number of children were significantly associated with burnout among HD nurses (p < 0.001, adjusted R² = 0.313). The working environment, individual factors, and specialist nurse training were significantly associated with HD nurse burnout and intention to leave (comparative fit index = 0.907; goodness of fit index = 0.930; root mean square error of approximation = 0.055).

DISCUSSION: There were notable regional differences in the burnout of HD nurses. This study contributes to the knowledge of the possible relationship of job burnout and intention to leave in HD nurses. It is suggested that improving the working atmosphere or interpersonal relationships and providing more training opportunities can alleviate job burnout in HD nurses.

PMID:33749129 | DOI:10.1111/hdi.12926

Am J Hum Biol. 2021 Mar 21:e23591. doi: 10.1002/ajhb.23591. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of the study was to evaluate the agreement between the Fels and Greulich-Pyle methods for the assessment of skeletal age (SA) in female youth soccer players.

METHODS: The sample included 441 Portuguese players 10.08-16.73 years of age who regularly participated in organized and competitive soccer. Standardized radiographs of the left hand-wrist were obtained and analyzed by an experienced examiner. SA was estimated with the Fels and Greulich-Pyle (GP) methods. Differences between SA and chronological age (CA) were used to define skeletal maturity groups: late, average and early maturing. In addition to descriptive statistics, Cohen’s kappa and Lin concordance correlation coefficients were used to evaluate agreement between methods.

RESULTS: Intraindividual differences in SA based on the two methods varied between 0.10 to 1.47 years among age groups with larger mean differences at older ages. Agreement of maturity classifications between methods was 74% at younger ages (under-13: kappa = 0.48; under-14: kappa = 0.39; Lin CCC = 0.68) and declined with increasing CA (under-17: 19% agreement; kappa = 0.001; Lin CCC = 0.11). About 19% of the total sample was skeletally mature with the Fels method and an SA was not assigned; in contrast, no players were skeletally mature with the GP method.

CONCLUSIONS: GP SAs were systematically lower than Fels SAs among female soccer players. Intraindividual variability in SAs between methods was considerable. The findings highlight the impact of method on estimates of maturity status.

PMID:33749124 | DOI:10.1002/ajhb.23591

J Vet Emerg Crit Care (San Antonio). 2021 Mar 22. doi: 10.1111/vec.13049. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the efficacy of fresh frozen plasma (FFP) with cryopoor plasma (CPP) to treat vitamin K-dependent factor deficiency in a canine in vitro setting.

DESIGN: In vitro laboratory study.

SETTING: University veterinary medical teaching hospital.

ANIMALS: Seven units of FFP and 6 units of CPP from unique canine donors from the university veterinary blood bank.

INTERVENTIONS: Canine FFP was adsorbed by oral barium sulfate suspension to mimic vitamin K-dependent coagulopathy. A sequential mixing study was completed by adding FPP or CPP to the adsorbed plasma. Measurements of prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, and factor activities of factors II, VII, and IX (FII, FVII, and FIX) were compared between the 2 treatment groups.

MEASUREMENTS AND MAIN RESULTS: When comparing the sequential addition of CPP or FPP to adsorbed plasma, the following had no statistical significance: PT (P = 0.94), aPTT (P = 0.66), FII (P = 0.05), and FIX (P = 0.90). There was a dose-dependent decrease with PT and aPTT and a dose-dependent increase with FII and FIX. In contrast, after the addition of either CPP or FFP, there was a significant difference between the treatment groups for the concentration of fibrinogen (P = 0.005) and activity of FVII (P = 0.044), with FFP resulting in a greater concentration of fibrinogen and CPP resulting in a greater concentration of FVII. Measurements of factor X (FX) were initially included in the study but were later excluded because FX appeared to be continually adsorbed even after the addition of CPP or FFP.

CONCLUSIONS: CPP partially corrected the coagulation times and concentration of vitamin K-dependent coagulation factors to the same degree as FFP. CPP, generally less expensive than FFP, may provide an alternative treatment option for vitamin K-dependent coagulopathies, although in vivo testing is needed.

PMID:33749109 | DOI:10.1111/vec.13049

Transpl Infect Dis. 2021 Mar 22:e13605. doi: 10.1111/tid.13605. Online ahead of print.

ABSTRACT

BK virus infections which usually remains asymptomatic in healthy adults may have different clinical manifestations in immunocompromised patient population. BK virus reactivation can cause BK virus nephropathy in 8% of kidney transplant patients and graft loss may be seen if not treated. Clathrin or Caveolar system are known to be required for the transport of many viruses from Polyomaviruses family including BK viruses. In this study, kidney transplant patients with BK virus viremia were divided into two groups according to the BK virus nephropathy found in kidney biopsy (Group I: Viremia +, Nephropathy + / Group II: Viremia+, Nephropathy -). Kidney biopsies were examined with immunohistochemical staining to determine the distribution and density of the Caveolin-1 and Clathrin molecules. Immunohistochemical staining of the 31 pathologic specimens with anti-caveolin-1 immunoglobulin revealed statistically significant difference between group-I and group-II. The number of the specimens stained with anti-caveolin-1 was less in group I. On the other hand, we did not find any difference between the groups regarding the anti-clathrin immunochemical analysis. According to these findings, caveolin-1 expression differences in kidney transplant patients may be important in disease progression.

PMID:33749103 | DOI:10.1111/tid.13605

J Magn Reson Imaging. 2021 Mar 21. doi: 10.1002/jmri.27604. Online ahead of print.

ABSTRACT

BACKGROUND: Intravoxel incoherent motion (IVIM) can provide quantitative information about water diffusion and perfusion that can be used to evaluate hepatic injury, but it has not been studied in hepatic injury induced by intestinal ischemia-reperfusion (IIR). Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) can provide perfusion data, but it is unclear whether it can provide useful information for assessing hepatic injury induced by IIR.

PURPOSE: To examine whether IVIM and DCE-MRI can detect early IIR-induced hepatic changes, and to evaluate the relationship between IVIM and DCE-derived parameters and biochemical indicators and histological scores.

STUDY TYPE: Prospective pre-clinical study.

POPULATION: Forty-two male Sprague-Dawley rats.

FIELD STRENGTH/SEQUENCE: IVIM-diffusion-weighted imaging (DWI) using diffusion-weighted echo-planar imaging sequence and DCE-MRI using fast spoiled gradient recalled-based sequence at 3.0 T.

ASSESSMENT: All rats were randomly divided into the control group (Sham), the simple ischemia group, the ischemia-reperfusion (IR) group (IR1h, IR2h, IR3h, and IR4h) in a model of secondary hepatic injury caused by IIR, and IIR was induced by clamping the superior mesenteric artery for 60 minutes and then removing the vascular clamp. Advanced Workstation (AW) 4.6 was used to calculate the imaging parameters (apparent diffusion coefficient [ADC], true diffusion coefficient [D], perfusion-related diffusion [D^* ] and volume fraction [f]) of IVIM. OmniKinetics (OK) software was used to calculate the DCE imaging parameters (K^trans , K_ep , and V_e ). Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were analyzed with an automatic biochemical analyzer. Superoxide dismutase (SOD) activity was assessed using the nitro-blue tetrazolium method. Malondialdehyde (MDA) was determined by thiobarbituric acid colorimetry. Histopathology was performed with hematoxylin and eosin staining.

STATISTICAL TESTS: One-way analysis of variance (ANOVA) and Bonferroni post-hoc tests were used to analyze the imaging parameters and biochemical indicators among the different groups. Pearson correlation analysis was applied to determine the correlation between imaging parameters and biochemical indicators or histological score.

RESULTS: ALT and MDA reached peak levels at IR4h, while SOD reached the minimum level at IR4h (all P < 0.05). ADC, D, D^* , and f gradually decreased as reperfusion continued, and K^trans and V_e gradually increased (all P < 0.05). The degrees of change for f and V_e were greater than those of other imaging parameters at IR1h (all P < 0.05). All groups showed good correlation between imaging parameters and SOD and MDA (r[ADC] = 0.615, -0.666, r[D] = 0.493, -0.612, r[D^* ] = 0.607, -0.647, r[f] = 0.637, -0.682, r[K^trans ] = -0.522, 0.500, r[V_e ] = -0.590, 0.665, respectively; all P < 0.05). However, the IR groups showed poor or no correlation between the imaging parameters and SOD and MDA (P [K^trans and MDA] = 0.050, P [D and SOD] = 0.125, P [the remaining imaging parameters] < 0.05). All groups showed a positive correlation between histological score and K^trans and V_e (r = 0.775, 0.874, all P < 0.05), and a negative correlation between histological score and ADC, D, f, and D^* (r = -0.739, -0.821, -0.868, -0.841, respectively; all P < 0.05). For the IR groups, there was a positive correlation between histological score and K^trans and V_e (r = 0.747, 0.802, all P < 0.05), and a negative correlation between histological score and ADC, D, f, and D^* (r = -0.567, -0.712, -0.715, -0.779, respectively; all P < 0.05).

DATA CONCLUSION: The combined application of IVIM and DCE-MRI has the potential to be used as an imaging tool for monitoring IIR-induced hepatic histopathology.

LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 2.

PMID:33749079 | DOI:10.1002/jmri.27604

J Magn Reson Imaging. 2021 Mar 21. doi: 10.1002/jmri.27602. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary artery (PA) anatomy in patients with transposition of the great arteries (TGA) after arterial switch operation (ASO) with Lecompte manoeuvre is different compared to healthy subjects, and stenoses of the PA are common. Magnetic resonance imaging (MRI) is an excellent imaging modality to assess PA anatomy in TGA patients. However, disease-specific reference values for PA size are scarce.

PURPOSE: To establish disease-specific reference ranges for PA dimensions and for biventricular volumes and mass.

STUDY TYPE: Retrospective.

SUBJECTS: A total of 69 pediatric patients with TGA after ASO (median age 12.6 years; range 5-17.8 years; 13 females and 56 males).

FIELD STRENGTH/SEQUENCE: 3.0 T, steady-state free precession (SSFP) and gradient echo cine sequences and four-dimensional time-resolved magnetic resonance angiography with keyhole.

ASSESSMENT: Right and left PA (RPA, LPA) were each measured at three locations during its course around the aorta. Ventricular volumes, mass, and ejection fraction were measured from a stack of short axis cine images.

STATISTICAL TESTS: The lambda-mu-sigma (LMS) method of Cole and Green, univariate and multivariate linear models, and t-test.

RESULTS: Centile graphs and tables for PA dimensions, biventricular volumes, mass, and ejection fraction were created. Univariate linear analysis showed significant associations (P < 0.05) between body surface area (BSA), height, and weight with systolic MPA and RPA diameter. In multivariate linear analysis, only BSA remained a strong predictor for main PA and RPA diameters. For biventricular volumes, the univariate linear model revealed a strong influence of BSA, height, weight, and age (all P < 0.05). On multivariate linear analysis, only body height remained associated.

DATA CONCLUSION: Uni- and multivariate linear analyses showed a strong association between BSA and PA diameters, as well as between height and biventricular volumes, and therefore, centile tables and graphs are presented accordingly. Our data may improve MR image interpretation and may serve as a reference in future studies.

LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY STAGE: 2.

PMID:33749058 | DOI:10.1002/jmri.27602

Exp Physiol. 2021 Mar 21. doi: 10.1113/EP089365. Online ahead of print.

ABSTRACT

NEW FINDINGS: Cardio-ventilatory coupling refers to the onset of inspiration occurring at a preferential latency following the last heartbeat in expiration. According to the cardiac-trigger hypothesis, the pulse pressure initiates an inspiration via baroreceptor activation. However, the central neural substrate mediating this coupling remains undefined. Using a combination of animal data, human data and mathematical modeling, this study tests the hypothesis that the heartbeat, by way of pulsatile baroreflex activation, controls the initiation of inspiration which occurs through a rapid neural activation loop from the carotid baroreceptors to Bötzinger Complex expiratory neurons.

ABSTRACT: Cardio-ventilatory coupling refers to a heartbeat (HB) occurring at a preferred latency prior to the next breath. We hypothesized that the pressure pulse generated by a HB activates baroreceptors that modulates brainstem expiratory neuronal activity and delays the initiation of inspiration. In supine male subjects, we recorded ventilation, electrocardiogram, and blood pressure during 20-min epochs of baseline, slow-deep breathing, and recovery. In in situ rodent preparations, we recorded brainstem activity in response to pulses of perfusion pressure. We applied a well-established respiratory network model to interpret these data. In humans, the latency between a HB and onset of inspiration was consistent across different breathing patterns. In in situ preparations, a transient pressure pulse during expiration activated a subpopulation of expiratory neurons normally active during post-inspiration; thus, delaying the next inspiration. In the model, baroreceptor input to post-inspiratory neurons accounted for the effect. These studies are consistent with baroreflex activation modulating respiration through a pauci-synaptic circuit from baroreceptors to onset of inspiration. This article is protected by copyright. All rights reserved.

PMID:33749038 | DOI:10.1113/EP089365

Public Health Nurs. 2021 Mar 22. doi: 10.1111/phn.12887. Online ahead of print.

ABSTRACT

PURPOSE: Pre-exposure prophylaxis (PrEP) prevents HIV yet uptake remains suboptimal across the United States. This paper evaluates the impact of outreach activities led by nurse supervised community healthcare workers (CHWs) on the PrEP care cascade.

METHODS: This is an observational programmatic evaluation of LGBTQ + community outreach between March 1, 2016, to March 31, 2020, as part of a public health initiative. Descriptive statistics are used to characterize the data by outreach type.

RESULTS: 2,465 participants were reached. Overall, a PrEP appointment was scheduled for 94 (3.8%) with 70 (2.8%) confirmed to have completed a PrEP visit. Success for each type of community outreach activity was evaluated with virtual models outperforming face-to-face. Face-to-face outreach identified nine persons among 2,188 contacts (0.41%) completing an initial PrEP visit. The website prepmaryland.org identified 4 among 24 contacts (16.7%) and the PrEP telephone/text warm-line identified 18 among 60 contacts (30%). The PrEPme smartphone application identified 39 among 168 contacts (23.2%).

CONCLUSIONS: Face-to-face community outreach efforts reached a large number of participants, yet had a lower yield in follow-up and confirmed PrEP visits. All virtual platforms reached lower total numbers, but had greater success in attendance at PrEP visits, suggesting enhanced linkage to care.

PMID:33749022 | DOI:10.1111/phn.12887

Magn Reson Med. 2021 Mar 10. doi: 10.1002/mrm.28742. Online ahead of print.

ABSTRACT

PURPOSE: Highly undersampled acquisitions have been proposed to push the limits of temporal resolution in functional MRI. This contribution is aimed at identifying parameter sets that let the user trade-off between ultra-high temporal resolution and spatial signal quality by varying the sampling densities. The proposed method maintains the synergies of a temporal resolution that enables direct filtering of physiological artifacts for highest statistical power, and 3D read-outs with optimal use of encoding capabilities of multi-coil arrays for efficient sampling and high signal-to-noise ratio (SNR).

METHODS: One- to four-shot interleaved spherical stack-of-spiral trajectories with repetition times from 96 to 352 ms at a nominal resolution of 3 mm using different sampling densities were compared for image quality and temporal SNR (tSNR). The one- and three-shot trajectories were employed in a resting state study for functional characterization.

RESULTS: Compared to a previously described single-shot trajectory, denser sampled trajectories of the same type are shown to be less prone to blurring and off-resonance vulnerability that appear in addition to the variable density artifacts of the point spread function. While the multi-shot trajectories lead to a decrease in tSNR efficiency, the high SNR due to the 3D read-out, combined with notable increases in image quality, leads to superior overall results of the three-shot interleaved stack of spirals. A resting state analysis of 15 subjects shows significantly improved functional sensitivity in areas of high off-resonance gradients.

CONCLUSION: Mild variable-density sampling leads to excellent tSNR behavior and no increased off-resonance vulnerability, and is suggested unless maximum temporal resolution is sought.

PMID:33749021 | DOI:10.1002/mrm.28742

J Orthop Res. 2021 Mar 21. doi: 10.1002/jor.25040. Online ahead of print.

ABSTRACT

BACKGROUND: Numerous studies have examined the histology of metal-on-metal hip tissues for evidence of a dose response to metal wear but have often reported inconclusive or contradictory findings. The aim of the present study was to address these discrepancies using multiple histological scoring methods to characterize the tissue features of one large group of revised metal-on-metal total hips.

METHODS: Periprosthetic tissues from 165 metal-on-metal hip revisions were examined for features of aseptic lymphocytic associated lesions (ALVAL) as rated using two scoring systems as well as rankings for macrophage and lymphocyte numbers, intracellular wear debris and necrosis. Correlations between histological features and clinical variables including gender and time to revision and implant variables including articular surface wear volume or visual taper corrosion scores were examined.

RESULTS: Both ALVAL scores reflected the macrophage dominated histology with average scores of 5.9/10 and 1.5/3. There was a statistically significant correlation between the original ALVAL score and wear rate per year (correlation coefficient= 0.17, p= 0.05) and a moderate correlation between the number of macrophages and wear particles and wear volume. There was no statistically significant correlation between wear and any other feature including lymphocytic inflammation or necrosis.

CONCLUSIONS: Strong correlations between combined cup and ball wear volume and histological characteristics were not observed, although the number of macrophages was more closely correlated with wear than lymphocytes or necrosis. This article is protected by copyright. All rights reserved.

PMID:33749015 | DOI:10.1002/jor.25040