4,101 research outputs found

    Novel 129Xe Magnetic Resonance Imaging and Spectroscopy Measurements of Pulmonary Gas-Exchange

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    Gas-exchange is the primary function of the lungs and involves removing carbon dioxide from the body and exchanging it within the alveoli for inhaled oxygen. Several different pulmonary, cardiac and cardiovascular abnormalities have negative effects on pulmonary gas-exchange. Unfortunately, clinical tests do not always pinpoint the problem; sensitive and specific measurements are needed to probe the individual components participating in gas-exchange for a better understanding of pathophysiology, disease progression and response to therapy. In vivo Xenon-129 gas-exchange magnetic resonance imaging (129Xe gas-exchange MRI) has the potential to overcome these challenges. When participants inhale hyperpolarized 129Xe gas, it has different MR spectral properties as a gas, as it diffuses through the alveolar membrane and as it binds to red-blood-cells. 129Xe MR spectroscopy and imaging provides a way to tease out the different anatomic components of gas-exchange simultaneously and provides spatial information about where abnormalities may occur. In this thesis, I developed and applied 129Xe MR spectroscopy and imaging to measure gas-exchange in the lungs alongside other clinical and imaging measurements. I measured 129Xe gas-exchange in asymptomatic congenital heart disease and in prospective, controlled studies of long-COVID. I also developed mathematical tools to model 129Xe MR signals during acquisition and reconstruction. The insights gained from my work underscore the potential for 129Xe gas-exchange MRI biomarkers towards a better understanding of cardiopulmonary disease. My work also provides a way to generate a deeper imaging and physiologic understanding of gas-exchange in vivo in healthy participants and patients with chronic lung and heart disease

    Stabilization and Resuscitation of Newborns

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    The majority of newborns do not need medical interventions to manage the neonatal transition after birth. However, every year millions of newborns worldwide require respiratory support immediately after birth, and another considerable number of newborns additionally require extensive resuscitation including chest compressions and drug administration. Despite a significant increase in knowledge and development of enhanced therapy strategies over the past few years, morbidity and mortality caused by failures in neonatal transition remain an important health issue. The purpose of this reprint is to support or introduce novel concepts and add information in the area of the “Stabilization and Resuscitation of Newborns”, aiming to improve neonatal care and, as the major objective, to enhance neuro-developmental outcomes

    OrvoskĂŠpzĂŠs 2023

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    Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice

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    The Special Issue entitled “Pediatric and adolescent nephrology facing the future: diagnostic advances and prognostic biomarkers in everyday practice” contains articles written in the era when COVID-19 had not yet been a major clinical problem in children. Now that we know its multifaceted clinical course, complications concerning the kidneys, and childhood-specific post-COVID pediatric inflammatory multisystem syndrome (PIMS), the value of diagnostic and prognostic biomarkers in the pediatric area should be appreciated, and their importance ought to increase

    Molecular Mechanisms and Therapies of Colorectal Cancer

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    Colorectal cancer (CRC) is currently the third leading cause of cancer-related mortality, with 1.9 million incidence cases and 0.9 million deaths worldwide. The global number of new CRC cases is predicted to reach 3.2 million in 2040, based on the projection of aging, population growth, and human development.In clinics, despite advances of diagnosis and surgical procedures, 20% of the patients with CRC present with metastasis at the time of diagnosis, caused by residual tumor cells that have spread to distant organs prior to surgery, affecting the patient survival rate. Standard systemic chemotherapy, alternative therapies that target mechanisms involved in cancer progression and metastasis, immunotherapy, and combination therapies are the major CRC-treatment strategies. In the advanced stage of CRC the transforming growth factor-beta (TGF-β) plays an oncogenic role by promoting cancer cell proliferation, cancer cell self-renewal, epithelial-to-mesenchymal transition, invasion, tumor progression, metastatic spread, and immune escape. Furthermore, high levels of TGF-β1 confers poor prognosis and is associated with early recurrence after surgery, resistance to chemo- or immunotherapy, and shorter survival. Based on the body of experimental evidence indicating that TGF-β signaling has the potential to be a good therapeutic target in CRC, several anti-TGF-β drugs have been investigated in cancer clinical trials. Here, we presented a comprehensive collection of manuscripts regarding studies on targeting the TGF-β signaling in CRC to improve patient’s prognosis and personalized treatments

    An Evaluation of Medication Safety related Communications in the Patient Healthcare Pathway in Kuwait

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    Background: Patient safety is a recognised public health issue. When post-market medication safety information emerges, the benefits and risks of the medication concerned are usually evaluated by drug regulatory agencies. The outcomes of such pharmacovigilance activities are communicated to the public, patients and other healthcare professionals (HCPs). The aim of these medication safety communications might vary from improving the intended recipients’ knowledge or attitudes to outlining specific actions to be followed by them. However, it is currently recognised that sharing medication-related information does not improve patients’ safety on its own if not accompanied by an accurate implementation of these recommendations in clinical practice. Despite their importance in protecting patient safety and subsequently affecting public health, no previous study was found to have evaluated or described the process of creating and disseminating medication safety communications by the Kuwaiti drug regulatory agency. Equally, no study was found to have investigated the impact of or the factors affecting the implementation of regulatory-related medication safety communications in Kuwait. Therefore, this thesis aimed to address these gaps in knowledge by evaluating medication safety communications in the patient healthcare pathway in Kuwait. Methods: This multiphase study was preceded by a systematic literature review of the factors affecting HCPs’ implementation of regulatory-related medication safety communications, using a narrative synthesis approach. Following the systematic review, multiphase research was initiated. This consisted of three phases, each of which focused on a specific stakeholder group involved in the process of medication safety communication. Phase 1 involved Kuwait Drug and Food Control (KDFC), an administration within the Ministry of Health (MOH), as the regulatory agency responsible for pharmacovigilance activities. This was a convergent mixed-methods study. Data collection in this phase included documents produced by KDFC or issued to KDFC relating to medication safety and three face-to-face interviews with KDFC employees involved in pharmacovigilance activities. Documents were analysed using a descriptive quantitative approach and a framework analysis technique. Phase 2 focused on healthcare professionals working in MOH hospitals in Kuwait. This phase was an exploratory mixed-methods study, where focus group discussions were conducted followed by the distribution of an online survey. The focus group discussions were analysed using a thematic analysis technique. In the second part of this phase, an online survey was developed based on Phase 1, the focus group discussions and the systematic literature review. Survey data analysis included descriptive analysis (frequency and percentile) and statistical analysis including principal component analysis (PCA) and the Kruskal–Wallis H test, which was followed by a post hoc analysis of variables that had significant results. Other statistical tests applied included Fisher’s exact test, the Mann–Whitney U Test, and multivariate regression analysis. Participants’ answers to open-ended survey questions were analysed using a conventional content analysis technique. Phase 3 was an interpretive phenomenology study. This phase involved semi-structured phone interviews with six female patients of childbearing age who used a valproate-related medication for epilepsy or migraine. These patients had been prescribed the valproate-related medication in one of six secondary hospitals and one specialist neurology hospital within the MOH hospitals. An interpretive phenomenological analysis technique was applied to analyse the transcripts. Results: The results of the systematic literature review indicated that the factors affecting HCPs’ implementation of medication safety communications occur at multiple levels. These levels included the sources or senders of the safety information (delays in the delivery of medications safety communications), healthcare institutions (hospitals’ position and interpretations of the recommendations), the HCPs (knowledge of the content of medications safety communications), and the patients and/or their carers (willingness to use the medication concerned). Phase 1 revealed a lack of legislation and a pharmacovigilance-specific policy. Results from Phase 2 reflected poor knowledge of the concept of medication safety communications within the context of pharmacovigilance and a lack of familiarity with the tools used by KDFC to communicate emerging medication information among HCPs. In the survey, although the majority of HCPs who responded were aware of the teratogenicity of VRM (65.1%, (n = 110/169)), only 2.6% had responded correctly to the statements of the VRM KDFC recommendations. More than half of the participants (57%) reported changing their practice to accommodate at least one intended KDFC recommendation. Providing female patients with written information (37.2%) and counselling female patients about contraceptive use (37.2%) were the most reported intended changes in practice. The most reported barriers to implementation included not having the capacity in terms of time and/or the infrastructure to implement the recommendations (33.8%). Four themes originating from patient interviews included (1) the timeline of the patient’s experience (2) varied knowledge and perception with valproate use, (3) patient’s expectations from HCPs and (4) experiences and preferences towards medication safety communications. Conclusion: Medication safety communications are essential tools for disseminating information related to medication safety updates to HCPs, patients and the public. This research identified challenges at the level of the sender (KDFC) and the intended recipients (HCPs and patients) that could reduce the ability of KDFC’s medication safety communications to reach clinical practices. The first step in increasing their reach is to adapt electronic methods for disseminating such information. Involving stakeholders, such as HCPs and patients, in evaluating the clarity and understandability of KDFC’s medication safety communications should be the focus of future research

    24th Nordic Conference on Computational Linguistics (NoDaLiDa)

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    Hepatic Encephalopathy

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    Hepatic encephalopathy (HE) is a complex neurological syndrome, characteristic of patients with liver disease, that causes a wide and complex spectrum of nonspecific neurological and psychiatric manifestations, ranging from a subclinical entity such as minimal or covert hepatic encephalopathy to a deep form in which a complete alteration of consciousness can be observed: overt hepatic encephalopathy. Both minimal and overt hepatic encephalopathy have a high impact on patients, caregivers, and national health services, driving substantial consumption of economic resources. In this Special Issue, we discussed the current state-of-the-art research, address ongoing knowledge gaps, and ongoing controversies related to the pathogenesis, diagnosis, and therapeutic management of hepatic encephalopathy
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